My experience in this is as a herbal practitioner of 20 years specialising in traditional western herbal medicine. During that time diseases and health problems have changed yet for all that I still function in a very similar fashion to that of my teacher, Dr. John Christopher. An American, he was born in 1909 and died in 1983; he carried the traditions of his teachers from Europe and the traditions of the native Indians and their indigenous pre-modern use of medicinal plants.
My traditional root dictate that I use what is known as singles and formulas as my main stay of whole plant use. During my talk I wish to explain what I mean by singles, formulas and whole plant use and the safe and known performance of my tradition and its plants which dates back many thousands of years. I also want to explain what is meant by standardised extracts, isolated constituents and whole herb tinctures and the dilemmas caused by the blurring of these three and ultimately the confusion this causes the public at large.
My colleague Michael McIntyre will have outlined many of the European and UK regulations this morning on his presentation entitled 'The Regulation and development of herbal medicine in the UK' He will have talked to you about the proposed new directive on Traditional Herbal Medicinal products. And he will have told you that by and large, the majority of herbal practitioners and many herbal medicine companies (many of whom belong to the British Herbal Medicine Association) are incredibly supportive of the Medicines and Healthcare products Regulatory Agency (MHRA) formerly known as the Medicines Control Agency and the Department of Health as this directive will safeguard the work of professional herbalists and bring regulation, quality and safety to the area of Over The Counter herbs for sale.
The herbal products to be included in the new directive will be whole plants used traditionally. This is something that the Prince of Wales choose to talk about in a lengthy article in the Daily Telegraph on Friday 18th April; it serendipitously coincides with my talk today and I quote:
In deriving drugs from plants, pharmaceutical processes tend to isolate and synthesize the active ingredient for the condition they wish to treat. The result, as with taxol, can indeed be life-saving but, in isolation, a specific chemical ingredient may produce side-effects that other constituents in the plant would normally help to counter-balance. For example, meadowsweet, a plant traditionally used to treat digestive disorders, contains salicylic acid which can cause internal bleeding (as aspirin does in people with sensitive stomach linings), but in meadowsweet, there are other chemicals, tannin and mucilage, that protect the stomach.
The new directive on Traditional Herbal medicine won't I believe include the 'Pharmacologically active' definition of a 'herbal remedy'. Word has it that Concentrated Standardized products will instead be considered for inclusion elsewhere under different legislation - at a later date!
Herbal remedies and medicines are sold worldwide in rapidly increasing numbers. Certainly the first world has taken a new interest in herbs, something it had shunned for the modern wonders of scientific medicine until more recently. The main exchange of herbs in the UK takes place over-the-counter, whilst 1% of herb use is serviced by herbal practitioners in clinic situations at present, although this looks set to change once the 12 or so UK degree and private training's provide more practitioners.
These over-the-counter herbal remedies fall into roughly 3 camps;
- Herbal formulae created by herbal practitioners and used traditionally for a long time.
- Whole plant standardized extracts, very often of a single herb.
- The isolated and perceived 'active ingredient' of a herb.
There are quite a number of research papers and studies undertaken on points 2 or 3.
There is a quite a lot of research into the efficacy of whole single herbs yet comparatively little on herbal formulas and herbal medicine as a whole in a complete holistic approach. The lack of research for these last categories (which represents how qualified herbalists work) is due to unavailable funding and incomprehension as to the way that herbalists work. The few double blind clinical studies performed on formulae that have been undertaken, have usually proven to be highly successful. Pharmaceutical companies clearly only want to market specific and isolable active constituents of plants as these can then be patented. In contrast herbal practitioners have always shared and honoured the tradition of community healing to include the handing down of herbal formulae and their knowledge.
Herbs are also very rarely used on their own. When they are they are called 'simples' and used in simple situations e.g. chamomile tea for stomach ache. Otherwise herbs can and are used on their own but usually as a part of a whole protocol where formulae are also employed. Hopefully the future will bring more evidence-based, clinical research.
So what is a whole plant standardized extract as opposed to an isolated plant constituent and what is a tincture?
Standardised Extracts and Isolated Constituents and Whole Plant Extracts
Standardised extracts come in many shapes and sizes. 'Whole plant standardized extracts' is where an extract is made using water and alcohol and then the levels of active constituents are detected and guaranteed to be above certain levels. For instance, milk thistle is sometimes quoted as having 80% silymarin; it will also possess all the other whole herb constituents, but these are generally not listed and some say that the internal balance of the plant is not significantly altered, but who knows? Others strongly argue the opposite and ask the question of, who and how it is decided which are the main active ingredients which require concentrating?
Isolated Active Constituents
The second type of herb extract is more like the one in the British Medical Journal study that I will talk of shortly. In this study and others like it, a herb extract is made with a variety of solvents like acetone, hexane and methyl alcohol. The perceived active ingredient is isolated and removed and the finished product is made by concentrating and purifying these active constituents and then 'blending' them into a carrier.
I will finally mention in passing something called 'supracritical extracts' where liquid CO2 is used to flush out the 'active ingredients'. I know little of this process and therefore make no personal comment.
Tinctures and How They are Made and Used.
Apart from herbal tea's this is the main way of offering whole herbs in western herbal medicine. A tincture is made with a solvent or 'menstruum' of grain alcohol and water. (Organic alcohol and distilled or spring water is preferred.) The proportions vary depending on active constituents and whether they need more water or more alcohol to be released. Marigold for instance is 90% alcohol and 10% water; a highly unusual ratio - whereas Echinacea generally requires 45% alcohol and 55% water like agnus castus which requires the same. The proportion of alcohol to water is vital and will vary very slightly according to each manufacturer and their concept of quality although guidelines exist. The same herb is often offered for sale in various strengths e.g. 1:2 or 1:5.
The strongest kind of tincture that I use in my clinic is a 1:2. This means that 1 kilo of herb has been used to 2 litres of menstruum. (Menstruum is a solvent which in the case of tinctures is a mix of alcohol and water.)
My colleague Paul Chenery from Rutland Biodynamics will be talking in greater detail on this subject shortly, he will discuss the virtues of the different strengths of tinctures. I believe the practitioner will make purchase choices based upon the strength of the particular herb to be used in the formula, in other words how strong or weak the herb in the formula needs to be. Acute diseases might require the more forceful strengths while chronic diseases would need more muted, weaker ones.
Tinctures are preferred by traditional western herbalists for several reasons.
1. The ease and quickness of taking them.
2. No preparation by the user bar diluting in water or fruit juice.
3. Very importantly the tincture is 'tasted', many vital activities for healing are initiated in the mouth and capsules or tablets circumvent this vital activity. For instance the bitter taste triggers pancreatic enzyme production. Whilst in the case of the well known plant Echinacea angustifolia (tea and tincture) it's healing activity starts in the mouth where the tingling it causes is triggered by the natural isobutylamides
4. Digestion is not required to 'break down' cellulose lignin and other plant structures where the active constituents reside. This leaves the person able to save the energy normally required in digestion; a tiring and often over-heating process.
5. Alcohol and water tinctures provide the ability to extract different plant constituents. Alcohol extracts oil, gums and resins and other constituents, while water extracts soluble fraction. Going back to Echinacea for a minute; the polysaccharides often cited as being one of its many immune stimulants can only be extracted in water so a tincture will provide this with its 55% water ratio.
6. Fresh plants are quickly preserved resulting in no loss of vitality and the killing of pathogens e.g. fungi etc.
Isolated Constituents in Plants Behave Very Differently to the known, safe Whole Plant
As I have said herbal practitioners very rarely use isolated constituents as employed in animal and clinical trials; which frequently precede the development of a pharmaceutical drug.
The story of Kava Kava is one to bear in mind while this new approach to plants is emerging. 'Kava kavas Latin name is Piper methysticum'. Over-the-counter kava remedies were produced whereby the kavalactones were extracted using hexane, acetone and 100% ethanol instead of the traditional water extraction used in Polynesia. The traditional use of kava is through a variety of extraction methods e.g. made with water as a tea. The method of extraction used by the pharmaceutical companies could explain why alarming adverse reactions occurred, which sensibly resulted in the Medicines Control Agency (to use its previous title) banning kava for use. (Herbal practitioners were understandably upset at having this long trusted herb removed from their medicinal shelves when many traditional western practitioners have used it safely for thirty years in their clinics.) We are wondering if it was the concentration of kavalactones that caused the devastating reactions on the people concerned. Yet there could have been other factors to include poor liver function of the patients and some kava users are known to have had a history of alcohol abuse as kava provides an antidote to a variety of unpleasant alcohol side effects. Kava is a sedative and well known to help insomnia, anxiety and nervousness. It's also an antiseptic, tonic, diuretic and analgesic.
Used in Polynesia for a wide range of treatments, it is often drunk on a daily basis as a beverage. It is not advised by herbalists to be used by those consuming liquids and foods that can compromise the liver as regular use of large doses will cause an accumulation of toxic substances in the liver.
Changing how a plant has been traditionally used can be very dangerous. We must be vigilant and not jump to hasty conclusions as to the 'magic bullet' plant constituent deemed of importance.
In the case of St. John's wort, heightened levels of hypericin (believed wrongly to increase its anti-depressant effect) only served to increase its light sensitivity effects. Later research showed that hyperforin, a constituent present in relatively small quantities may well be in fact the real antidepressant component.
Research done on Echinacea often cites the polysaccharides as being 'the important chemical constituents', yet only water can extract polysaccharides, as I said earlier; so the famously high alcohol concentration tinctures used in the early 1900's (Lloyd Brothers, US) had very little or no polysaccharide activity and yet powerful proof reflects it's highly potent immune stimulating abilities coming presumably from plant chemistry other than the polysaccharides. In fact very likely it is in part from the isobutylamides, 'the tingle factor' which I mentioned earlier. The isobutylamides are proven to have antimicrobial action. (Incidentally polysaccharides are mostly destroyed in the digestive tract.) Modern herbalists use a tincture of approximately 45% alcohol and 55% water in order to extract all potential bio-chemistry.
In the case of Ginger, isolated constituents behave very dangerously on their own, for instance gingerol and shogaol proved mutagenic in isolation and zingerone showed to suppress mutagenic activity; clearly the whole plant is vital.
A story from my clinic recently, illustrates this further. A lady came to me with secondary me-tas-tasis on the liver after breast cancer. Her story was that she tried standardised milk thistle (Silymarin) and after 2 weeks on this product her liver enzymes increased negatively and she had to stop taking the standardised extract. Of course I have absolutely no proof that the problem was the fault of the standardised extract even though her consultant felt it was to blame.
Whole Plant Formulas and Why and How They Are Employed
Herbs often rely on their effect on a multiplicity of chemical constituents. Their synergistic buffering and interplay is often not understood even under close scientific scrutiny. Yet it is their whole and unique make up that creates the medicine for the qualified herbalist. The herbalist will frequently amplify this feature by creating formulas.
Formulae or Polypharmacy are useful for a number of reasons; all aim to ultimately support and stimulate the body's own natural ability to create health.
Potent herbs may be chosen. This is because a single herb may have an effect that is too direct or strong.
When a set of effects is desired that no single herb provides. (As with cooking a meal, a range of ingredients can provide taste and nutritional diversity that provides a more satisfactory outcome from many points of view.)
When the effect of a combination of herbs is different than the mere sum of the individual herbs found in the formulation as outcomes are enhanced, buffered and balanced. Qualified herbal practitioners from all herbal traditions choose Polypharmacy for this reason.
With chronic diseases, the problem is deep seated and many organs are involved. In which case these will need multi-dimensional support and the length of treatment will also affect the choices.
Different choices will be needed for acute ailments that will need to reflect a more combative and potent strategy than the gentler more supportive and diverse strategy needed for chronic diseases.
Formulas used Over-The-Counter will need to reflect that the individual herbs chosen and the resultant formulae have a safe, supportive and effective result. These formulae have longevity of traditional use and are used because they are known to be well-balanced for a wide range of people. They often originate from formulas that are hundreds of years old with a few adjustments. In the U.S. 'The National Formulary' is a semi-official treatise of standard old formulas not found in the U.S. pharmacopoeia. Many formulas in it are still to be found being used by U.S. herbalists, while many are sold Over-The-Counter. (The work was published around the early 1900's.)
Formulas have always had a built in substitute factor because availability can fluctuate. Wildcrafters (herb collectors) will tell you that problems ranging from harvest difficulties to weather conditions can mean that certain plants become out of access either temporarily or longer term; the herbalist has always had to be ready to substitute. Nowadays over-harvesting can produce the same problem; however the increase in herb farming has alleviated this problem to some extent and more needs to be encouraged thus assisting our health and economies in a myriad of ways.
Roger Williams drew our attention to the concept of biochemical individuality in his book published in the 1950's called 'Biochemical Individuality'.
In herbal medicine the individual can be catered for once his / her constitution is diagnosed, the formulae can then support this.
There are Many Systems of Herbal Medicine, but there are Three Main Ones in Use Today in the UK, all use Formulas.
There are three main systems of herbal medicine worldwide from which all of the above formula's exist and they are: Ayurveda, Chinese and Western Traditions but many others exist to include Tibetan Herbal Medicine, Polynesian Herbal Medicine, Jamaican, the herbal medicine of the South American Rainforests, the list is endless. The most ancient system of herbal medicine is Ayurveda. The second great system is Traditional Chinese Medicine and the third system of healing is Traditional Western Medicine of which the lineage relates back to the Egyptians. The Egyptians influenced the Greeks, Romans and Persians and then the traditions travelled into Medieval Europe which has then followed in broken and unbroken lines since then to Modern Europe. The fusion of Native American herb use and plant use was subsequently introduced in the 18th century which still dominates British Herbal Medicine to this day. It is to this Western European Traditional System that I have trained in and belong to, as I said earlier. My reasons for choosing this system were largely based on a very old credo concerning herbal medicine. 'Use the plants around you' as a trained horticulturalist it seemed a natural choice. Formula's are not only created by people and their needs but also their locality and proximity to the peoples of that area. A single herb is capable of treating a wide variety of maladies and very often the herb or herbs are to be found growing abundantly right at your feet.
On the other hand, like people, plants have always migrated and Modern Herbal Medicine is no exception and is often to be seen 'borrowing' plants and ideas from other lands and peoples, particularly where climate and soil comply. A very natural progression and one hopes that the ethnic peoples whose plants are used will more consistently be acknowledged and earn a living from this sharing, as in the past they rarely have. On this subject it is useful to listen to Mr Rosenthals presentation before lunch and also to reflect on Robert Nash's warnings about geographic locations and chemical constituent quality issues.
Agnus Castus Studies and the Whole Plant
There have as I said earlier been a number of randomised controlled clinical trials on the efficacy of both standardised extracts and isolated constituents of herbs; all have contributed hugely to our understanding of these plants but a herbalist would feel that an isolated plant constituent couldn't be directly related to a specific action. The other effects of the other constituents will be missing. Lets look at agnus castus in the light of this.
Agnus castus (Vitex agnus castus) from the Verbenenaceae family is a shrub stroke small tree (3-9ft tall). It grows in the Mediterranean and through to western Asia. The fruits are the parts used medicinally are small, hard, reddish-black drupes with a persistent calyx. The fruits contain 4 seeds each and are grey/black. They taste slightly peppery and are resinous when chewed. Often found growing next to streams, it also grows in very dry areas as well and sometimes only a few feet from the sea. It's opportunistic nature ensures a weed-like capacity to grow in town and country alike.
Agnus castus chemistry
The three main fractions of the vitex's fruit include: essential oil; two iridoid glycosides, aucubin and agnuside; fixed fatty oil; and the flavone, casticin (steinegger, 1988). Three further minor flavonoids were recently characterised as 3, 6, 7, 4'-tetramethyl ether of 6-hydroxykaempferol, the 3,6,7-Me ether of 6-hydroxykaempferol, and the 3,6,7-triMe ether of quercetagetin (Wollenweber, 1983).
The dried fruits contain about 0.5 to 1.22% essential oil, which is mainly composed of cineol (25.2%), alpha- and beta- pinene (39.7%), and limonene (14.8%) (Mishurova, 1986). The leaves, which are also used in folk medicine, contain: 3 iridoid glycosides, aucubin, agnuside, and eurostoside; (Goerler, 1985) the flavonoids homo-orientin and luteolin-7-glucoside; and 0.76 to 0.82% essential oil (Mishurova, 1986).
Agnus castus has been in use for well over 3,000 years, it was and still is a highly prized herb, used by many cultures. In the last 70 years it has slowly re-gained it's special place in our health armoury and can be seen for sale in our high streets. Used to treat the symptoms of female hormonal imbalances to include PMS (and most associated symptoms), menopause and peri-menopause, depression, uterine fibroid cysts and more. Although able to affect and regulate hormone levels, the plant does not actually contain hormones. A research study in Germany carried out in 1998 indicated that the berries of agnus castus works by regulating the
pituitary gland often called the 'master gland' or 'orchestra conductor'. The pituitary gland sends chemical signals to other glands such as ovaries and 'tells' them how much to make. Vitex agnus castus helps trigger a more balanced hormone production. Agnus castus is particularly known for increasing progesterone levels in women. The effect on the pituitary gland is gained by stimulating and therefore increasing lutenising hormone which results in higher levels of progesterone during the second phase of a women's cycle. It is at present construed that agnus castus is best at treating PMS symptoms where low progesterone levels are associated with high prolactin levels. Vitex decreases prolactin levels by binding directly to dopamine receptors in the pituitary gland according to 'in vitro' and animal research. It is thought to be best used on waking in the morning when the hypothalamic pituitary axis in the brain is most active. However despite exhaustive research, the constituents responsible for this hormonal activity have not been isolated and yet 3,000 years of effective use lies behind it.
An important hormonally-active herb, and to date the only herb with a progesterone-type activity. Agnus castus is a key herb for menstrual problems, from pre-menstrual syndrome (PMS) and many of the symptoms that accompany it - such as breast swelling and tenderness, to irregular or absent periods. by increasing progesterogenic activity it appears to help balance progesterone and oestrogen production by the ovaries throughout the menstrual cycle. In PMS it should be taken for some months to see the full benefit, which can often be significant - with bloating, breast tenderness, irritability and depression all reduced. However it is unlikely to help and may make matters worse in symptoms in PMS type D (high progesterone, low oestrogen) which is characterised by depression, crying, confusion and insomnia. It is not particularly helpful for menstrual pains and cramps, though it will help to regulate irregular periods, tending to shorten a long cycle and lengthen a short cycle. Agnus castus is valuable in treating migraines and acne when linked to the menstrual cycle, and can be valuable in severe cases of acne in men and women.
(50 Vital Herbs by Andrew Chevallier, Amberwood Publishing, 1998)
British Medical Journal Randomised Controlled Study of Agnus Castus
Let us now look at the British Medical Journal trial on Agnus Castus fruits. Using the isolated constituent method of extraction explained earlier. The constituent Casticin was used, which is a flavonoid.
The British Medical Journal published a paper entitled 'Treatment for the Premestrual Syndrome with Agnus Castus Extract: Prospective, Randomised, Placebo Controlled Study'
R. Schellenberg, senior consultant, for the study group.
The study medication was derived from the fruit extract ZE 440: 60% ethanol m/m, extract ration 6-12:1, standardised for casticin: one 20mg tablet once daily. (plus Placebo.)
Zeller AG, CH-8590, Switzerland supplied study medication and sponsored the study through the clinical research org Praxis, Klinische Arzneimittelforshung, Polheim, Germany.
Conclusion on Study
'Agnus castus is a well tolerated and effective treatment for the premenstrual syndrome, the effects being confirmed by physicians and patients alike. The effects are detected in most main symptoms of the syndrome. This herbal remedy ought to be considered a therapeutic option in women whom a causal origin for this syndrome cannot be established.'
* More information on this study can be found on the website: http://bmj.com/
Study Results and Comments from a herbal practitioners point of view.
The results from this study were very interesting from a herbal practitioners point of view. It was interesting to note that the isolated constituents casticin was called a 'Herbal Treatment'. I think we need to be aware that generally speaking most herbal practitioners would not consider this herbal medicine. The isolated constituent and whole herb are frequently blurred.
The study was good in so much as it was continued over three monthly cycles and used people. In vitro and non-human studies cannot be taken as equivalent to human ones; although the information produced can be useful, it can also mis-inform.
This study was not chosen for criticism but rather as it is indicative of a wider situation.
Before we leave agnus castus I'd like to show you how it is often used in formulas by herbal practitioners.
I want to complete my talk by focussing on how herbal practitioners use herbs in formulae and how in detail a formula works.
Formulae are very roughly divided into two camps; those used to treat chronic deep seated diseases and those used to treat acute ailments. It is often likely that in either situation more than one formulae would be prescribed, with anything form 5 to 20 herbs in any one formula. With say two or even three formula prescribed together, the ingestion of a wide range of plant constituents reflects our 'pre-farming' or 'hunter-gatherer' instincts. Of the two formulae camps let us first look at chronic diseases, this denotes a person that is weak because of prolonged illness. Overall the body must be built up and supported. Excessive or overly powerful strategies are not possible. Tonic and building herbs will predominate bearing in mind that one must not push the body too strongly in any particular direction. As always in herbal medicine the aim is to provide special tools to enable the body to find it's own way to balanced good health. This will not only mean providing herbs but also sound and supportive nutritional advice, exercise, bodywork e.g. massage, appropriate detox regimes and so on. Formulas for chronic problems should aim for gradual improvement. One foot in front of the other as it were. Slow and sure rebuilding of weakened foundations, until vitality returns and stronger herbal formulas and wellbeing strategies can be employed.
As I said tonic, supportive herbs will be the mainstay of the formula and compliment these tonics; some will be chosen because they are going to gently detoxify the body or warm it up, in which case if a strong herb has been chosen it's effect will need to be buffered to tone down it's effect and moderate it's outcome.
Acute diseases need a different approach altogether as I have said. The opposite action is the approach and mild tonic herbs are inappropriate because it's vital that a more stimulating combative mode should be sought. Once the acute phase is over then tonics and recovery herbs should be used, in order to bring back the body to full recovery. This strategy often prevents re-occurrence of the acute phase. So, acute ailments demand pro-active strategies and so very often a main herb is placed in a high proportion within the formula and it will be expected to posses focussed and powerful properties to deal with the 'acute' problem. Added to this are small amounts of stimulating herbs to better empower the work of the main herb added also are anti-spasmodic or musculartory, relaxing herbs to reduce general tension and finally a small amount of demulcent or soothing herbs in order to provide gentle action and protection.
Herbs renowned for their unrelenting strategies to kill all kinds of microbes are in this formula. The whole formula makes a useful defense programme for early indications of illness and for assisting full blown acute conditions. It is an antiviral.
The primary part in this formula is Echinacea root and the acetate provides more information on this - Echinacea purpurea it plays a vital role in detoxifying the blood, moving and clearing the lymph system and building up the attack and protection abilities of the immune system. Extensive scientific research over 20 years has revealed that this plant is able to have a plant-antibiotic effect, due to its
(a) cortisone like activities
(b) it's ability to assist in synovial membrane healing,
(c) support of collagen through hyaluronic acid protection,
(d) production of systemic interferon,
(f) stimulation of T-cell lymphocytes and,
(g) tumor suppression.
Highly supportive of the Echinacea is Oregano leaf - Origanum vulgare this herb is a treasure-house of invaluable chemistries, and it's ability to disarm a wide range of microbes to include virus, bacteria and fungus is invaluable here. It generally warms and settles the stomach and encourages the liver - all helpful steps to surviving and recovering while the immune system wages war.
Thyme herb - Thymus vulgaris is a highly antiseptic plant in a wide range of immune situations of fungal, bacterial and viral origins. It is also a powerful tonic (adaptogenic). This supportive and rebuilding aspect of thyme alongside its more combative qualities, makes it an ideal inclusion in this formula.
Chamomile flower - Chamomilla recutita is renowned as a stomach settler with demulcent properties and will therefore sooth and relax in turn the whole body. It is a natural probiotic as it regenerates positive stomach and bowel flora. It greatly relaxes and soothes the entire nervous system. It has a very profound effect on the immune system and its ability to fight and survive poisoning derived from vicious types of bacteria and virus.
Cayenne pod - Capsicum minimum stimulates the circulation which helps to mobilize the other herbs around the body for greater effect and assists in better delivery and supply of oxygen. Additionally cayenne contains capsicidins, an invaluable aspect of its biochemistry (found in the seeds of capsicum) which are thought to have antibiotic activity.
Trace Amount of Chamomile Essential Oil - this is included to pep up the whole formula. (The oral use of essential oils in very minute quantities is an old tradition amongst herbal practitioners.)
A Few Final Thoughts:
Let us remember the individual and the collective. The individual plant and how important verification of the species at collection point is. The individual constitution of the person who is to be helped. The 'collective idea' of the whole plant and the collective idea that it isn't the isolated constituent in the rain forest plant but the way the indigenous peoples have safely used it for thousands of years. Let us consider that the so called active constituent can be an illusion.
I want to encourage the modern and traditional groups to work together. We need the growers, agro-ecologists, plant collectors, biochemists, pharmacists, anthropologists, practitioners and patients alike to collaborate to make genuine, safe progress. Not just for the first world but for the world over. Not just for now but taking care for the future.
Thank you for listening.
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