alternative medicine, medicine, naturopath

Doctor, Shut Up and Listen



HARRISBURG, Pa. — BETSY came to Dr. Martin for a second — or rather, a sixth — opinion. Over a year, she had seen five other physicians for a “rapid heartbeat” and “feeling stressed.” After extensive testing, she had finally been referred for psychological counseling for an anxiety disorder.

The careful history Dr. Martin took revealed that Betsy was taking an over-the-counter weight loss product that contained ephedrine. (I have changed their names for privacy’s sake.) When she stopped taking the remedy, her symptoms also stopped. Asked why she hadn’t mentioned this information before, she said she’d “never been asked.” Until then, her providers would sooner order tests than take the time to talk with her about the problem.

Betsy’s case was fortunate; poor communication often has much worse consequences. A review of reports by the Joint Commission, a nonprofit that provides accreditation to health care organizations, found that communication failure (rather than a provider’s lack of technical skill) was at the root of over 70 percent of serious adverse health outcomes in hospitals.

A doctor’s ability to explain, listen and empathize has a profound impact on a patient’s care. Yet, as one survey found, two out of every three patients are discharged from the hospital without even knowing their diagnosis. Another study discovered that in over 60 percent of cases, patients misunderstood directions after a visit to their doctor’s office. And on average, physicians wait just 18 seconds before interrupting patients’ narratives of their symptoms. Evidently, we have a long way to go.

Three years ago, my colleagues and I started a program in Harrisburg designed to improve doctors’ communication with their patients. This large urban hospital system serves a city with a population of about 50,000, together with the surrounding metropolitan area of more than 550,000 people.

The hospital faces particular challenges: The city has a high poverty rate (32 percent, compared with the state average of 13 percent), and the metro area has a high rate of childhood obesity. Over all, nearly a third of people around Harrisburg are uninsured, compared with about one in 10 for the rest of Pennsylvania.

Our project started with a simple baseline assessment of how we as doctors communicated with our patients. Observation soon revealed that physicians introduced themselves on only about one in four occasions. And without an introduction, it’s no surprise that patients could correctly identify their physician only about a quarter of the time.

Brief, rushed physician encounters were common, with limited opportunity for questions. A lack of empathy was often apparent: In one instance, after a tearful patient had related the recent death of a loved one, the physician’s next sentence was: “How is your abdominal pain?”

We developed a physician-training program, which involved mock patient interviews and assessment from the actor role-playing the patient. Over 250 physicians were trained using this technique. We also arranged for a “physician coach” to sit in on real patient interviews and provide feedback.

Over the next two years, patient satisfaction with doctors, as measured by a standard questionnaire, moved the hospital’s predicted score up in national rankings by a remarkable 40 percentile points. Several studies have found a correlation between higher patient satisfaction scores and better health outcomes. In one, published in The New England Journal of Medicine, Harvard health policy researchers reported that higher patient satisfaction was associated with improved outcomes for several diseases, including heart attacks, heart failure and pneumonia.

The need to train and test physicians in “interpersonal and communication skills” was formally recognized only relatively recently, in 1999, when the American Board of Medical Specialties made them one of physicians’ key competencies. Although medical schools and residency programs then began to train and test students on these skills, once physicians have completed training, they are seldom evaluated on them. And doctors trained before the mid-1990s have rarely, if ever, been evaluated at all.

I realize that many colleagues may see methods like ours as too intrusive on their clinical practice and may say that they don’t have the time. But we need to move away from the perception that social skills and better communication are a kind of optional extra for doctors. A good bedside manner is simply good medicine.

A passionate diabetes specialist told me how she sat down with a patient to understand why he was not using his diabetes medications regularly, despite numerous hospital admissions for complications.

“I can’t continue to do this anymore,” he told her, on the verge of tears. “I’ve just given up.”

She placed a hand on his shoulder and just sat with him. After a pause, she said: “You have a heart that still beats, and legs you can still walk on — many of my patients don’t have that privilege.”

Five years later, recalling this episode, her patient credits her with inspiring him to take better care of himself. The entire encounter took less than five minutes.

herbs, history, medicine

Living Medicine

Stephen Harrod Buhner On Plant Intelligence, Natural Healing, And The Trouble With Pharmaceuticals  by AKSHAY AHUJA

 Herbal tea with honey, wild berry and flowers on wooden background

AKSHAY AHUJA is the production manager for Ploughshares. He lives in an apartment in Somerville, Massachusetts, with his wife and young son, but dreams of returning a piece of land to wilderness and roaming it with a miniature Sicilian donkey.

Writer and herbalist Stephen Harrod Buhner comes from a long line of healers, but he describes his childhood home life as deeply unhealthy. “Love was in short supply,” he writes. “Certainly kindness was.” Born in 1952, he found solace in the time he spent with his great-grandfather C.G. Harrod, a country physician in rural Indiana. At his great-grandparents’ farm, Buhner felt cared for and in touch with nature in a way he didn’t at home. He also observed his great-grandfather’s approach to treating patients, which he describes as “hands- on, compassionate, and personal.” Buhner remembers wanting to grow up to be just like him, but that type of country doctor was already becoming a figure of the past.

At the age of sixteen Buhner left home and moved to California, where he attended college and “majored in the sixties.” He eventually landed in Colorado’s high mountains, where he rebuilt a turn-of-the-century cabin that he lived in for four years, teaching himself the forgotten crafts of the nineteenth century. In his early thirties Buhner became severely ill with abdominal cramping. Rather than have surgery, as his doctors recommended, he took a friend’s advice and attempted to cure himself using a medicinal plant. The herbal remedy worked, and the experience revived Buhner’s interest in healing. He began studying, and later writing about and practicing, herbal medicine. The road to becoming a “plant person and Earth poet,” in Buhner’s words, wasn’t easy. “I had to take a lot of other jobs along the way to make enough money to survive: doughnut baker, construction laborer, woodworker, mansion restorer, furniture maker, rare-book seller, and so on.”

Over the years he has written more than twenty books on everything from treating Lyme disease to brewing herbal beers to fasting. The topics may seem unrelated, but for him they are all aspects of the same subject: “the luminosity of the land and of the Earth.” His most recent book is Plant Intelligence and the Imaginal Realm: Beyond the Doors of Perception into the Dreaming of Earth.

In 2013 I read the updated edition of his 1999 book Herbal Antibiotics, which is about how plant medicines can be used to treat bacteria that have become resistant to pharmaceuticals. The book focuses on the flaws in what Buhner calls “technological medicine” and suggests different ways of approaching disease, the natural world, and our own mortality. “By declaring war on bacteria,” he writes, “we declared war on the underlying living structures of the planet.” Buhner maintains that, through indiscriminate use of antibiotics, we have created “superbugs” with few effective pharmaceutical treatments, wreaking havoc in hospitals and making future pandemics likely.

My mother, a biochemist, happened to be doing research in India on antibiotic-resistant bacteria, and I shared Herbal Antibiotics with her. We would take walks with my infant son and talk about the landscape of disease that may be our generation’s legacy to him. It was on one of these walks that I decided to interview Buhner about bacteria and plant-based healing.

Buhner currently lives in Silver City, New Mexico, next to one of the largest wilderness areas in the U.S. Along with two partners, including his wife, Trishuwa, he operates the nonprofit Foundation for Gaian Studies (, named for the Gaia theory, which says that our planet’s biosphere can be viewed as a single complex organism. Buhner describes himself as an “independent scholar, amateur naturalist, and citizen scientist.” He is also a thoughtful and vocal critic of Western medicine and the bureaucratic and regulatory environment that has grown up around it. The sixty-two-year-old still takes no pharmaceuticals and treats himself entirely with herbal medicine. “I trust the plants with my life,” he says.

Ahuja: What’s wrong with the medical system in the United States?

Buhner: At the end of the nineteenth century there were many different kinds of physicians practicing in the U.S. Allopaths — those we call “doctors” today — were only one of them, and they were among the poorest groups. The homeopaths were the most numerous and the richest.

Allopathic physicians argued that their training was based on science and was thus more legitimate than other medical traditions and would provide safer interventions. With a lot of lobbying, they managed to get control over medical practice and have the other approaches outlawed. After the discovery of penicillin in the 1920s, antibiotics became a primary aspect of allopathic practice. The drugs were so effective against previously difficult-to-treat problems, such as infections in burn patients, that Western cultures completely embraced allopathic healing. In 1942 the entire world’s supply of penicillin was 8.5 gallons — about seventy pounds. By 1999 the production of antibiotics in the U.S. alone reached 40 million pounds per year.

Unfortunately medical researchers’ beliefs about bacteria were very wrong. Researchers said it would take roughly a million years for bacteria to develop widespread resistance to antibiotics through spontaneous mutations. They assumed bacteria were stupid, when in reality bacteria are highly sentient. They communicate by means of a sophisticated language — as sophisticated as ours. They recognize their kin. They protect their offspring. They create chemicals designed to produce specific outcomes in living systems, which certainly fits any definition of toolmaking.

We’ve tended to view bacteria as a collection of single-celled entities, but when many of them join together, it’s more proper to look at them as a swarm intelligence. And complex organisms such as plants, animals, and insects are, in essence, communities of bacteria.

Ahuja: How does bacterial resistance challenge the current medical model?

Buhner: Since the end of World War ii, the medical establishment has been promising that we are heading for some sort of disease-free future in which we will live to be 120 and never get sick. They almost imply that they can cure death. Scientists’ inability to predict the bacterial response undermines the entire worldview that the allopaths disseminated — and still disseminate — about disease and the nature of the world around them. The Centers for Disease Control estimates that, in 2011, 722,000 people picked up infections in hospitals. About 75,000 of those patients died during their hospitalizations. And some sources give a much higher figure for annual deaths from hospital-acquired infections.

The allopaths’ lock on medical practice, which they insisted would create safer outcomes for the public, has not done so. All it has done is give one orientation toward healing a virtual monopoly on practice.

Ahuja: How would you treat a resistant infection with herbs?

Buhner: One woman who had undergone multiple antibiotic regimens over several years for a resistant staph infection (mrsa) came to me for help. She was about to lose her foot to the disease. It took a month to turn her condition around using an African herb called Cryptolepis sanguinolenta. Commonly used to treat malaria, it is also a broad-spectrum, systemic antibacterial with no side effects — at least, after twelve years of use, I have seen none. Vancomycin is the antibiotic often used for staph infections. Besides being frequently ineffective, it has a long list of side effects. In general, herbal medicines have fewer or no side effects. They are composed of hundreds of synergistic compounds, whereas pharmaceuticals have just one compound, or perhaps a few. We have been at this antibiotic business only a century or so. Bacteria have been around for 3.5 billion years.

Ahuja: Won’t bacteria eventually become resistant to plant medicines?

Buhner: With a pharmaceutical, the bacteria analyze the single compound and generate solutions to it, which they then pass on to other bacteria. Plants, on the other hand, generate multiple compounds that deactivate resistance mechanisms in the bacteria and enhance the activity of the plant’s natural antibacterials. Bacteria cannot easily counteract that kind of complexity. Also, plants aren’t trying to kill all the bacteria on Earth. They merely want to create a balance in which the plants and bacteria set limits on each other’s behavior.

Ahuja: There seems to be a general view that herbal medicine is fine for coughs and colds, but when something gets serious, you go to a conventional doctor.

Buhner: The pharmaceutical companies’ advertising campaigns are very good. We have been trained to think of technological medicine as the only reliable type and other approaches as outdated remnants of a prescientific age. Yet the majority of people I have met don’t much like doctors or hospitals. The one thing modern medicine is good at is trauma. If I get hit by a car, I will go to a hospital. But other than antibiotics and some surgeries, hospitals have little they can offer to cure disease. They can only address the symptoms.

Pharmaceutical companies are in business to make as much money as they can. They try to develop drugs you have to take for years and years, such as medicines for high blood pressure or depression. You don’t get well; you just keep taking the drug.

In Africa people can’t afford to pay a dollar a day for a malarial drug from a Western corporation, and their infrastructure is not going to support producing the drug themselves. They need to do something else. So in Nigeria, for example, researchers asked local healers what herbs they were using. The researchers ran tests to find the best ones and the most effective methods of preparation. Then they took the seeds to people and told them how to grow and use the plants. That’s not the Star Trek vision of the future that a lot of Americans want, but it’s the most ecologically sound and empowering.

Ahuja: Besides the profit motive, what else is wrong with pharmaceuticals?

Buhner: For the most part, they are not biodegradable. And these are dangerous substances to release into the environment. To receive a patent, the natural molecule that forms the base of the drug — which is often a molecule found in plants, fungi, or bacteria — must be tweaked slightly, altered. That now-alien molecule causes disruptions in ecological functioning that are impossible to predict.

Also, adverse drug reactions are a leading cause of death in the U.S. By some estimates more than a hundred thousand people a year die from using prescribed medication. I think the number is far greater. If herbalists caused that many deaths, there would be an outcry heard on the moon.

Ahuja: In Herbal Antibiotics you mention the dangers of what you call “monotherapeutic thinking.” What do you mean by that?

Buhner: The germ theory of disease, once it became entrenched, generated the idea that the onlylogical treatment was to kill the germ with a drug. And it did indeed work for about fifty years before it began to fail. It even influenced herbalism. Herbalists who wanted to be accepted by physicians as legitimate healers began to mimic the medical approach. Specifically they looked for the “active” constituents in the herbs they were using, then tried to standardize the herbs for that constituent. They sought to become plant-drug doctors. Many of us got caught up in that for a while, some permanently. It still influences the field, especially at the regulatory level.

Ahuja: You write that most community herbalists “haven’t been trained to believe they know some ultimate truth about the nature of plant medicines or reality as a whole.” Why is that an advantage?

Buhner: Because a reductionist, mechanistic approach to nature, such as the one our culture has inherited from scientists of the early to mid-twentieth century, is deeply flawed. It tries to understand complex aspects of nature by dissecting them and looking at the parts. Though in many areas science has advanced beyond such reductionist thinking, this oversimplified model is still taught in schools. Children are told that humans are the most intelligent organism on the planet, while other organisms are mostly unintelligent and do not possess complex language or make tools or have empathy. Science has realized that the sun does not revolve around the Earth, but it still thinks it revolves around human beings.

The alternative is to understand the Earth as a living organism that modulates its own environment, not as inert matter to be used in any way we see fit. As psychologist James Hillman once put it, “It was only when science convinced us the Earth was dead that it could begin its autopsy in earnest.” The greatest act of disobedience to the mechanistic model is to reclaim our empathy with the living planet, our ability to feel.

Ahuja: Hasn’t a reductionist, mechanistic approach led to many scientific advances?

Buhner: Perhaps, but it has also led to tremendous ecological damage, and its limitations are revealed almost daily. Researchers continue to find evidence of spontaneous self-organization in matter, such as occurs in living creatures. If molecules, for instance, are packed tightly into a closed container, they will synchronize and begin to act as a unified whole. Mathematician Steven Strogatz writes in his book Sync that “these feats of synchrony occur spontaneously, almost as if nature has an eerie yearning for order.” I find his term “eerie” interesting; it suggests an underlying fear of this aspect of the natural world.

A biological organism is something more than the sum of its parts. Consider the people you know. If you analyze them according to height, weight, age, where they went to school, and so on, you are engaging in a form of reductionism that will never capture their essence. We intuitively understand this to be true with human beings, but we have been trained not to apply it to every other substance and life-form on the planet.

When spontaneous self-organization occurs in a biological organism, the organism immediately begins working to keep its new self-organized state intact. It analyzes incoming data and generates responses. In other words, intelligence arises in the system. It does not matter if this is a bacterium or a plant or a person or an ecosystem. The organism becomes extremely sensitive to all incoming data, because anything that touches it might destabilize it. Tiny inputs can create huge changes in self-organized systems. For example, infinitesimal amounts of estrogenic chemicals from drugs, preservatives, plastics, detergents, and other sources have been found to cause sex alterations in males of nearly every species studied.

To get an idea of how sensitive self-organized systems are, imagine a toy top spinning. If you touch it even slightly with your fingertip, you will alter its movement considerably.

Reductionists view the world as a static stage upon which humans are the only actors capable of intelligent movement — though they might allow that some animals possess rudimentary thought processes. The reductionists believe they can take organisms apart to understand them, but that is not how life works.

Ahuja: What was your first experience with herbal medicine?

Buhner: When I was thirty-four, I became quite ill with severe abdominal cramping. The doctors didn’t know what it was. I met a local herbalist, and she mentioned that a certain plant growing in the forest around my house was good for my condition. The doctors wanted to do exploratory surgery, but instead I ate some of the plant. The pain was about half as severe the next time it happened, and the next time about half again, until finally it just went away. After that, I began to take control over my own health.

Ahuja: What was the plant?

Buhner: It was a perennial herb called osha. I just dug up the root and began eating it. It’s got a spicy, celery-like taste. Not only did I feel my body getting better, but I could feel, inside, some living entity that cared about me. It’s difficult to explain, because it’s not something we generally talk about in the West. When you use a living medicine and get well, you feel that the world is alive and aware and wants to help you. People often talk about saving the Earth, but how many times have you experienced the Earth saving you?

Ahuja: How do you go about treating patients as an herbalist?

Buhner: It’s a relationship, not a technique. My clients often feel lost and alone in their suffering. They need human companionship and also a sense of companionship with the living world. If I can, I’ll take them into the woods and introduce them to the plant that will be helping them.

In my book The Lost Language of Plants I tell the story of a twenty-eight-year-old woman who was going through a messy divorce. Her periods were extremely irregular, with heavy cramping and bleeding, and her hands were always cold. I could see that her whole body was closed off, curled in on itself. Her fingernails were chewed back deeply, as if she were eating herself alive.

I told her there was a plant I thought she should meet. We went for a walk through a pine forest, and when she saw the plant at the edge of a stream, a kind of force drew the woman and the plant together. The plant was Angelica, which has been used for thousands of years to help treat menstrual cramping. She spent a long time with it, then said a prayer and asked for help, and then we went to look for just the right Angelica. When we found it, she dug up the root, which has a beautiful smell. On the walk back she held it close to her. She was already carrying herself differently. The healing had started.

She took a tincture made from the root, and within a month her period had normalized.

Ahuja: How do you know which individual plant is the right one?

Buhner: From experience I can tell when a plant is healthy or not. I can tell when a plant has more-potent medicine in it. I can tell when a plant wants me to pick it and when it doesn’t.

It’s difficult to explain how I know this. It’s like when you come home and ask your partner, “How are you?” and he or she says, “Fine.” You know something’s wrong, right? But if you just looked at the content of the statement — “Fine” — you couldn’t tell. It’s what’s inside that matters. That’s what herbalists are talking about when they refer to the “energy” of a plant. The strongest plant will feel slightly different from the others.

In herbalism you’re engaging in a deeper sort of communication. The words, the phrasing, the posture, the kind of touch you have — they all matter. Compassion needs to flow in all directions. These are things that the medical model doesn’t take into account. It can’t. That’s one reason why imposing the medical model on the herbal model will destroy it.

Ahuja: My mother studies antibiotic-resistant bacteria, and when she read your book, she was excited by the possibility that plant medicines might help reduce dosages of conventional antibiotics. As a scientist sympathetic to herbal medicine, she wants a synthesis between herbal and technological medicine. I get the sense that you want to keep them separate.

Buhner: That’s not actually true, but I am highly suspicious of Western medicine. I’ve met some wonderful physicians. I’ve also met many patients who don’t like how they’re treated, or the outcomes they get, or how much the treatment costs, but they feel as if they don’t have any other options. In the U.S. the medical establishment is like a powerful trade union. It tries to co-opt whatever works and control it.

Ahuja: How has it been trying to do this with herbal medicine?

Buhner: The Food and Drug Administration [fda] has established what it calls “good manufacturing practices,” or gmp, which control how commercial herbal medicines are produced. It does this under the guise of promoting safety, but most herbal medicines come from mom-and-pop operations who sell what they make in locally owned stores. The regulations now in place will put those people out of business. One community herbalist told me she thought it would cost between half a million and a million dollars for her to meet the gmp requirements.

It was the big herbal companies — and the pharmaceutical companies that wanted to break into this market — that lobbied for these regulations. As smaller operations disappear, the remaining, larger, ones will make a great deal more money and ultimately be bought by pharmaceutical companies. Public safety won’t really be improved. The herbal medicines that hurt people, in my experience, are always produced by large companies. The problem is usually a contaminant or a misidentified herb.

Ahuja: Is the gmp an entirely bad thing? How else can we ensure the safety of herbal medicines?

Buhner: If you are looking only at the larger herbal companies, the gmp is definitely a good thing. The problem is that the fda applied the same rules to the small companies, which have never had the kind of problems the larger companies do. Most community herbalists do it for love. They often harvest their own plants in the wild or grow them or buy them from farmers they know. They are not selling millions of units and buying herbs by the ton. That’s the primary reason consumers almost never have adverse reactions to their products. They are craftspeople, not manufacturing companies.

Ahuja: Can you imagine a balance between pharmaceutical and herbal medicine?

Buhner: I’m hopeful that, over time, a balance will be found. In a functional healthcare system, people would know how to do some self-care. You don’t need to go to a doctor for colds and flu. There are easy ways to treat them that everyone should know. If a problem is more serious, you should go to a community herbalist. If it’s beyond him or her, then you go to a natural practitioner who has expertise in the organ system that’s causing the problem. Finally, for certain rare illnesses, you find physicians who use a combination of pharmaceuticals and herbs. This is what the Chinese are already doing. They don’t have a cultural bias against herbs; they just want to use what works.

Ahuja: Many of the plants in Herbal Antibiotics aren’t native to North America. Do you think people should look first to the plants around them for medicine?

Buhner: The book was written to offer alternatives to people who might die of a resistant infection, so I wanted to list anything they could reliably use in that circumstance. Still, many natural antibiotics do grow in the United States. I live in the Southwestern desert, and Bidensgrows all around our house. It’s invasive. Sida grows along the Gulf Coast, and some Sida species grow in New Jersey and Pennsylvania. They’re all considered invasive. In fact, the most potent medicines for emerging infections tend to be invasive botanicals that people are busy trying to eradicate.

These invasive plants don’t move into a region for no reason. Take, for example, the berberine-containing plant Phellodendron. Berberine-containing plants are used to treat parasites and infections from yeast, fungi, bacteria, and viruses. Goldenseal was probably the most potent berberine plant in the U.S. until it was harvested to near extinction in the late 1800s. Phellodendron, which is a massive tree, is invasive in exactly the same range that goldenseal was removed from. And if you cut just one branch, you’ve got enough berberine plant to last a year.

I’ve found that if people are ill, the plants they need are almost always growing in their vicinity. I’ve watched plant populations change around me in places I’ve lived for thirty-some years, and they seem to shift in response to changes in my own disease complexes. This sounds airy-fairy to the Western reductive mind-set, but people have been commenting on it since Hippocrates. Plant populations rise and fall according to the needs of the ecosystem in which they grow, and that includes the animal life there, which includes us.

Ahuja: Yet we act to remove invasive plants from ecosystems.

Buhner: Yes, these plants are seen as alien invaders. I joke that the Republicans want to get rid of immigrant people, and the Democrats want to get rid of immigrant plants. It’s not understood that dandelion and burdock and a host of other common plants are non-natives that moved in and established a balance with local ecosystems, or that many of the plants targeted for eradication happen to be effective against the exact diseases that local people are contracting. Japanese knotweed is invasive all up and down the East Coast, and its root is the most specific medicine there is for the treatment of Lyme disease. There’s a Lonicera species — a honeysuckle — that reduces mosquito egg-laying wherever it grows. The mosquitoes that it discourages happen to carry dengue fever and a number of other viruses that cause encephalitis — inflammation of the brain. And it turns out that the plant is also a treatment for inflammation in the central nervous system.

When plants move into an ecosystem, they do so because the ecosystem has been disrupted. The problem is that people don’t ask, Why is this plant here?

Ahuja: What’s an example of a plant population that changed near you?

Buhner: I contracted rather severe pneumonia about sixteen months ago, primarily from overwork. Six months before that, a species of Bidens began growing around my house that is a specific treatment for the damage that occurred in my lungs. So is the bark of the elm trees and the horehound plants that grow around my house.

Ahuja: Isn’t it human activity that normally introduces invasive plants? How do we differentiate between our own actions and the will of an ecosystem?

Buhner: The real question is: Who is the dominant species — us or the plants? Perhaps we are just an organism that functions to spread plant species around the world. Remember: plants and bacteria are integral to the functioning of the planet. We are not. If we disappeared tomorrow, things would continue on relatively smoothly. If the plants and bacteria disappeared, we would not last long.