I wanted to start this new series by explaining my understanding of the pluralistic nature of health care practices that exist in societies.  I feel like this is important, if a little dry, because some of the terms I use are also used by people outside the field of anthropology.  A lot of times, they don’t mean the same thing when they use them. That doesn’t mean anyone is necessarily wrong. It just speaks to the lack of cohesion between disciplines, which is one of my strongest critiques of academia.

Anthropologist, Arthur Kleinman first defined a society’s health care system as being comprised of the popular, folk, and professional sectors- a model which has been useful to me in studying the history of botanical therapeutics and guides my research.

Professional Healers

The professional healthcare sector is comprised of academically trained providers such as MD’s, naturopathic physicians and yes, clinical herbalists.  In the past these healers were often trained through an apprenticeship to a professional healer who agreed to see to their education.  Prescriptive formulas or professional patent medicines employed by professionals. frequently replaced native medicinal preparations.

Cultural healing systems such as Āyurveda and Traditional Chinese Medicine (TCM) were constructs of the literati of their respective cultures. Study was most frequently limited to males of the elite class and required education of a level that few received in these highly stratified societies. Education in these modalities is still expensive to obtain.

Western practitioners mentioned by those discussing the history of herbal medicine, such as Hippocrates, Dioscorides and Gerarde, were academic elites and as such members of a professional healthcare sector.  Even Culpeper, who was frequently at odds with the English College of Physicians,  began his career having been apprenticed to an apothecary.

This leads me to tangent for a moment on the term “herbalist” which I find problematic to use. Historically,  the term herbalist came about as a descriptor for someone who had authored an herbal.  Take John Gerarde as an example. Gerarde is often spoken about as an herbalist. Technically he did author (or at least plagiarized) one of the most influential herbals of the Middle Ages,  but he  was not a naturalist.  He was a junior warden of the  Barber-Surgeon’s Company and consequently a professional physician, in his era.  He was also a sexist, asshat-but I digress.

Folk Healing

The folk health care sector is comprised of the traditional healing specialists of a community. Historically, these healers included lay midwives, fairy doctors, bean feasa, and “cunning folk” with far more in their repertoire than the therapeutic delivery of plant medicine. Folk healers often work from a framework influenced by indigenous cultural ideas about the spirit world influencing health and the communal aspects of wellness.

Folk healing is not limited to a particular spiritual practice. In many Gaelic communities, priests were called on as folk healers when it was thought an illness was caused by the supernatural-what anthropologists sometimes term a “naturalistic” cause. Modernly it is at least theorized that a lot of these types of  conditions were due to mental health problems and mental health professionals now fill this roll.  To my way of thinking that is just wrong.  But more on that later.
Popular Health Care or Domestic Medicine

Popular health care refers to self-care, or familial care, practices informed by popular knowledge. Often knowledge of this nature is passed along by word-of-mouth – frequently as home remedies that are passed down through the generations or through community skill-sharing networks. In its strictest sense, the term does not apply to any particular type of remedy. It also is not limited to addressing illness. Self-care in the form of diet, hygiene and simple protective measures are aspects of the popular healthcare culture.

Regardless of what you may be told, self-medication is not a thing of the past; it was simply co-opted by the pharmaceutical companies. People stopped self-medicating with the old home remedies and started buying over-the-counter replacements. We take aspirin or Tylenol instead of decoctions. We stopped making ointments and turned to Vick’s Vaporub, Ben Gay, and more recently –essential oils. Grandma’s marshmallow syrups were outperformed-first by patent medicines and then by Robitussin.

The work I have done in trying to educate people about the early practice of domestic medicine is in part, trying to illustrate the widespread nature of early popular health care practices.  I am also restore our respect for women as the “keepers and carriers of knowledge”.

Where Do We Fit? 

It kind of depends on what you practice.    Traditional Western Herbalism employs  botanical therapeutics in a way that is grounded in Greek Medicine and the professional practice of physicians the late 19th and early 20th century.

This is what some anthropologists call cultural sedimentation. Basically what this means is that professional medical practices of the past are picked up by the folk healers and common folk,  who keep using these methods even after the professionals have moved on to new approaches. Tinctures are an example of a type of patent medicine used primarily by the professional healthcare sector, until modern times.

That in no way invalidates their usefulness.  Botanical preparations were the only type of medicine animals and humans had at their disposal until the beginning of the 20th century and we certainly learned much about their effective delivery through centuries of  trial-and-error experimentation.

All of that being said,  I really hesitate to label Traditional Western Herbalism as folk healing because I think it overlooks many of the responsibilities

Reviving the Bean Feasa

harvestThe blog is going to switch gears for a bit to discuss the focus of much of my research. You will have to read through to the end of this series of posts, before I get to my very exciting new project based on this research, but I do hope that you find it informative, and maybe even a little inspiring, along the way.

I suppose I should explain to people who read my last series of posts,  that  research questions don’t always have to do with interventions and outcomes.  They cannot be always be answered through microbiology or clinical trials.  Some recently acquired readers might even be surprised by the fact that the person in this picture  likes to spend hours pouring over research about how plant agents impact neurotransmission or endocrine function.

While I will admit a certain compulsion towards understanding the mechanisms of action behind a botanical therapy, I do not believe cutting edge technology is the solution to creating wellness in our society. I have no doubt it will cure  some diseases but that is a very different thing than creating wellness.

When studying clinical herbal practice in college, I began to question whether herbal clinicians should  only focus on the therapeutic delivery of botanical medicine or if our roles extends to something more?  This question led me to my anthropological studies and an investigation of the pluralistic nature of health care practices in early societies, which I will explain tomorrow.

I am often asked why I think this is important work? While working on my senior project, I realized that at one time, before religion and capitalism interfered, wellness in a community was created through respectful cooperation of many types of healers.  Much of my research has been gathered in my efforts to understand what this cooperation looked like and how to make that work in a modern context.

The conclusion I arrived at is summarized best by the abstract of my thesis Reviving the Bean Feasa: Building Resilient Communities through Folk Healing which states:

This thesis draws from the study of the past, when there existed an alternate paradigm of healing. These healing systems, grounded in autonomous self-care and common production of locally available plant remedies, seemed to be more successful than modern professional systems at addressing the social and ecological determinants of health. These popular health cultures, consequently, contributed to the resiliency of their communities. I recommend the wide dissemination of this common knowledge of our ancestors regarding health as means of restoring wellness to the land, the plants and the people.

I’d like to distribute the thesis to a wider audience, but I doubt that many people would be interested in sitting down and reading the whole 130 page of my thesis, here on my blog, so I am going to spend some time discussing some of the beliefs I presented in it.

These are the beliefs that informs much of what I write for other people and classes I teach at herb conferences. They are the beliefs that informs how I work in my community.  They are the beliefs that that inform how I live.

Friends who know me know that it has been a weird couple of years for me personally, but just the other day my dear friend Wolf commented that despite this series of deeply disturbing challenges, I haven’t let it crush my spunky spirit. I attribute that capacity to what these beliefs.

Let’s Talk About Research IV: Finding the Research

Avoiding the Research Rabbit Hole

Most beginning students start poking around in the research literature when they start writing their own monographs and they really have no idea what they are doing.  You can get sucked so far down the research rabbit hole that your productivity plummets,  if you don’t learn how to narrow a search.  * You can do this even pretty easily even if you DO know how to narrow a search. 🙂 *

The best way to do this is to use specific search terms and to limit yourself to the most recent research.  I focus on not using much research that is older than five years and actively avoid using anything older than ten.

I recommend SciCurve to beginners.  It teaches some common research terms while you are poking around, but  the visuals also show connections that will give you some direction in your research. I am not going to fib the aesthetics appeal to me, as well. Below is what shows up if you ask for a report on kava.

Untitled

kavaTo the left is what it looks like when you ask it to show you a map.  Maybe its because I am a visual learner, but I really like this.  Also if you have your Lazy Scholar add-in, every time you click on one of the bubbles, it will look for the full text of the article on the web.

Now-omics is not as pretty but it is specific to the life sciences and it lets you generate a news feed built with only recent research.  I like it for beginners because they can plug in a very broad search term like a particular plant and then use the topics down the side to filter the larger search.

TRIP has a really handy free search function that allows you to frame your search using the PICO mnemonic I mentioned last week.  The following search returned 98 results defined by type, such as ongoing clinical trials, primary research or guidelines.  Untitled picture

 

 

 

 

Spharro is probably my favorite for keeping up with the latest research, though.  You can make “channels” about every plant if you want.  The platform really allows you to narrow down what you see based on  information about authors, journals and MeSH terms you may have seen on SciCurve or TRIP.

This is the point when people ask why I just don’t stick with Pub Med? There are so many reasons I don’t like Pub Med-most of them having to do with its limitations. Those just getting into research aren’t likely to know common medical subject headings (MeSH) or research terms that will produce good search results.  Pub Med also doesn’t give you the ability to search for a single type of literature or ongoing clinical trials, the way TRIP does or only search through the most up-to-date literature the way Nowomics does.  By that I don’t mean the date of publication so much as I mean that often times the versions of the papers offered on  PubMed are not the final version of the publication.

Specific Paper

In my last few posts on research, one thing that should have become clear is that it is really hard to critically assess a study, if you don’t have the whole thing. Using abstracts limits your understanding of the study design and you don’t get to see the concluding discussion. The sites above are going to send you to a lot of papers where everything but the abstract is hidden by a paywall.   Don’t give up though because there are ways around that, sometimes.

The first thing  I like to suggest is installing the Chrome add-on Lazy Scholar. It is useful for looking for full text versions of a  paper and it will suggest alternative titles that might be related to your research. If you hit Cite, it sends the citation to your clipboard for pasting into a document. My favorite thing about it is the nifty little option that lets me block non-scholarly sites on the Internet for one hour. If Lazy Scholar has not worked its magic and located a copy, the next thing to try is an old-fashioned Google Scholar  search using  the title of the article followed by pdf.

If you can’t find it that way, try to determine if you can get some access to online databases through your local library.  Depending on the size of your library,  availability may be limited.  If that is the case, move on to looking to see what your state library offers.  Many of you might not know this is a thing, but your state library will send out a card number to anyone who lives in the state which grants access to their online resources.  What is available varies by state, but here are some examples.

Iowa
South Dakota
Kansas

Finally, check around some of the places where researchers are able to post their own research for sharing.

Researchgate
Academia
Scribd
PubPeer
Peer Evaluation
ScienceOpen

I think this will wrap up what I have to say about research for right now unless readers have questions.  I am very much involved in my own research projects right now as I am updating my class outlines for the MIdwest Herb Fest and Traditions in Western Herbalism Conference with the most recent information I can find.

Let’s Talk About Research III: Clinical Appraisals

Stephany Hoffelt Iowa City HerbalistsOften students in medical and nursing programs are asked are asked to write up a clinical appraisal of a research study. The first step to doing this is to summarize the study using the PICO mnemonic.  This is a method which biomedical researchers are taught to formulate good clinical questions which can also be used to evaluate research papers.  Using this method is going to be most useful if you have solid knowledge of biological sciences and some sort of clinical experience.

Keep in mind here that  while you are trying to assess how well put together the study is, ultimately what you want to figure out is how this study is relative to your work.

P—Patient
What are the characteristics of the subject or population?
N=number of subjects.
What is the condition or disease being examined?

I—Intervention or exposure
How did the researchers interact with this subject or population?  Were they treating the condition or observing risk factors?

C—Comparison
Was there is the alternative to the primary intervention, for example a placebo or were two interventions being compared?  Were two different populations or being observed?

O—Outcome
What is the relevant outcome- improvement, recovery, remission, death? Did any complications develop? Did the intervention have any side effects.

After you have identified these elements of the study you can ask yourself some of the following questions.

Are the Results Valid?

Was the sample of subjects clearly defined and representative of what you might encounter in clinical practice?

Were the subjects’ prognosis similar?  Their clinical characteristics need to be similar enough to draw valid conclusions. Were they all from a similar demographic, at a similar stage in a disease? If there was co-morbidity were the coinciding conditions similar?   What are possible confounding variables which means could other factors have contributed to the outcome?

Was the follow-up sufficiently complete?  Did the study follow at least 80% of the patients through to recovery or an alternate disease outcome such as remission or death?

Were objective and unbiased outcome criteria used?  This means was there some sort of mechanism incorporated into the study such as a standardized pain scale which eliminate the use of subjective conclusions on the part of the researchers as to subjects’ improvement.

What Are the Results?

How likely are the outcomes over time?  If this is a cohort study were the outcomes and exposures to risk factors assessed similarly.  You might see a  relative risk ratio mentioned in RCT’s and prospective studies.   In retrospective studies, they will mention the odd-ratiol

How logical and accurate are the researcher’s conclusions?  What is the confidence interval- that is the measure of how likely you would be to achieve the same results if you repeated the study?

How Can I Apply the Results to Care of Clients?

Were the study subjects  and methods of management similar to those in my practice?  Can I apply these results to interventions I use with clients in my practice?

You can also look to see who funded the study and whether or not the researchers declared any conflicts of interest, but honestly there are a lot of ways to hide that information.

After you ask yourself all these questions you can summarize the study by listing its strengths and limitations.