Pharmacognosy and Magical Thinking

There's a long ongoing debate about the state of healthcare in these United States of America. I'm not going to hold forth on it for long, but there are some things I think could stand to be repeated and emphasized in the hopes they might sink into the minds of the general population. Is American healthcare bad? No. We're the top of the world in standard of care, medical technology, and keeping people alive. Is our payment system, balanced as it is on the unstable platforms of health insurance and government subsidies, broken? Yep, sure is. Is the next best step handing the whole kit and caboodle over to the government for single-payer? Um. Have you looked at the Veteran's Administration and what they do to our brave fighting men and women recently? Noticed the stories about the NHS coming out of England and Canada are not all roses and cherries?

With that out of the way, one of the topics that floats up often and makes me grit my teeth is the cost of drugs and medicine. There's a lot of moving parts, and most people don't think it through other than 'I can't afford that!' or 'Big Pharma is keeping me from getting my miracle drugs that will cure cancer, flatulence, and female orgasm!!!11!elventy!!'

Sigh. That's not how this works. That's not how any of this works. Are big pharmaceutical companies manned by angels? Hardly. Look at the recent shenanigans around the sale of a patent to an Indian nation in a desperate ploy to keep the drug from going generic as a recent example. Not to mention the EpiPen debacle. But the fact remains that getting a drug through the stringent trials to develop it from concept to compound to proven safe medicine is a long, arduous, and expensive path. Fully 90% of the compounds that start out, fail. If you follow that link to Derek Lowe's excellent blog, you'll find that there are a lot of hopeful remedies that simply don't do anything, don't do what was expected of them, or worst of all, potentially injure and kill patients. The FDA has not been deaf to the pleas of the public to fast track drugs that could be of great value. In the end, though, their role is to be a gatekeeper for good reason.

Which brings me to the titular thought behind my post. I do teach wildcraft, in a small way, but one thing I no longer teach is the medicinal value of the plants that can safely be gathered as food. I have  a lot of reasons not to. One is that dosing is tricky. Very tricky. The saying one man's meat is another man's poison came from this practice, after all, of observing that a natural medicine might cure, or it might kill. And that's not easily predictable, even in modern medicine. Another good reason I don't teach is that people don't listen. Look. You know as well as I do that the vast majority of people, when they learn that a little of something is beneficial, will immediately ask themselves 'but what about more? More is better!' and when we're talking about medicinal compounds, that's potentially fatal.

Pharmacognosy deals with the natural drugs obtained from organisms such as most plants, microbes, and animals. Up to date, many important drugs including morphine, atropine, galanthamine, etc. have originated from natural sources which continue to be good model molecules in drug discovery. Traditional medicine is also a part of pharmacognosy and most of the third world countries still depend on the use of herbal medicines. Consequently, pharmacognosy always keeps its popularity in pharmaceutical sciences and plays a critical role in drug discovery.

The other thing I see in conversations about natural remedies (which, to be honest, is disingenuous labeling, but I'll come back to that in a minute) is that Big Pharma doesn't want to have them discovered, is suppressing them, or wants to claim them and lay a patent on them. That's woefully ignorant. Big Pharma would adore to find a natural compound that could be easily synthesized, efficacious, and safe for all to use. See above about the 90% fail rate. Big Pharma is trying to use natural compounds, has been for a century if not more.

So let's dive into natural compounds that humans can use as poiso... er, drugs, for a minute. Plants (or animals, or bacteria) don't produce them solely for our benefit. There's a reason they need them to do something, and often that reason is toxicity. Caffeine, cocaine, and capsaicin, just to name a few alliterative examples, are all produced as natural pesticides. Plants don't care to be chewed on, and all these compounds act as 'ew, yucko' to the things that want to eat them. Only, being human, we're all 'oh, that tingles...' and off we go down the rabbit holes where the mushrooms are magic and overdoses are all part of the fun and games.

The other part about natural medicines, and this is one I've written about in the past, is dosing. Plants are producing these compounds for a reason, and they may not produce as much in a given season. Heck, even time of day for harvest can make a difference. Any gardener worth their salt knows that peppers grown in the cool damp weather are simply not as spicy as those grown in hot dry conditions. Herbs are best harvested on sunny afternoons for full aromatic essences to be present. When you buy, or harvest, plants you intend to use as medicine, you DO NOT KNOW how much of that active compound is in them. You might unintentionally underdose yourself, or overdose. You don't know. You can't without a battery of tests, most of which require sensitive and expensive laboratory equipment to conduct. The state of modern medicine? Is a lot better than 'here, drink this foul smelling potion and if you're still alive tomorrow I'll give you more.' Now, we can precisely and accurately synthesize the exact compound we want from that 'natural remedy' and give it with confidence knowing exactly how much we're dosing the patient with. Is it a perfect system? No. Do we live a hellova lot longer than our grand and great grandparents did? Yes, yes we do.

But still, I see the magical thinking pervasive in the culture. "Oh, plants were good enough for my ancestors, that's good enough for me." Which completely ignores the reality of snake oil, quacks, and such who have always been with us. Mercury was also a medicine. Do you want to swallow some of that? I thought not.

"Big Pharma is greedy!" Yeah. You saw above about the 90% fail rate? What do you think that costs? I'm not, again, saying pharmaceutical companies are a perfect resolution to the problems. But handing it all over to the government doesn't solve the money issue. Someone, somewhere, is going to pay for the drugs you want. Government issue? Those super expensive new experimental drugs are simply not going to exist. Also, yes, drugs cost more in America than other places. We don't subsidize them the way other countries do, and we can afford it. No, Princess, you aren't poor. Not compared to that kid in Africa who's going to die, or have his brain development retarded, unless he gets three $5 doses of worm medicine. You picking up the tab for your acne medicine so you don't have *gasp* a flaw on your skin allows the drug companies to charge less in parts of the world where they can't afford it like you can. Want to make a difference in the world? Buy your damn medicine and stop whining. Yes, I know there are people who need life-saving medications and can't afford them. There are also programs to help people like that. Here in the US, if you die because you're poor, it's because you chose to do so.

I probably sound harsh. I feel harsh. I'm normally all nice, and empathetic, and I do feel the pain of those who have no treatment for their aches and ailments and seek relief in vain. But I also see that many who seek alternative treatments or who complain about the cost of their medicine don't actually need them. Don't realize that they can better afford to pay a bit more so those who are truly sick and broke can have subsidies for their vital medication. Or they want to use homeopathy and 'natural' remedies to treat their children and thus cause death and disfigurement because they are too indoctrinated to see the reality that modern medicine is a god-given miracle.

Wild Ginger, Asarum canadense

I photographed this Wild Ginger flower a few days ago in the Ohio woods. While Asarum is a folk remedy, it is also a toxic plant, one that can destroy your kidney function. The other common name, Snakeroot, can lead to it being confused with Cimicifuga racemosa, which also goes by that common name as well as Black Cohosh (they look nothing alike, but the similar names are a big problem).

There's no easy out when it comes to pharmacology and economics. Safe, effective drugs cost a lot to discover, develop, and produce. Illnesses do not always react to medication, but it's easier to administer drugs than to admit you don't know what's going on, as a doctor. Overmedication is a thing. And it's not always the doctors. Patients who want to feel better demand drugs, antibiotics, and placebos in the form of homeopathy simply because they don't want to do nothing. They are desperate to get well, or thinner, or back to feeling like 20 with a 60yo body. And desperation is never a good place to make decisions in.