AS A PHYSICIAN with botanical training and a longstanding interest in medicinal plants, I work as an advisor to several groups promoting research on herbal medicine, one of which is the American Botanical Council in Austin, Texas. Recently, the director of the council, Mark Blumenthal, asked me to comment on a letter he received from a woman in Chicago, extolling the health benefits of ginkgo. She was taking pills containing an extract of the leaves of a tree, Ginkgo biloba, native to China and now widely planted in cities throughout the world, because it is resistant to air pollution. The tree has attractive, fan-shaped leaves, used for centuries in traditional Chinese medicine, and the female trees provide edible nuts. Only in recent years has a concentrated, standardized extract of ginkgo leaves become available in the West. This product has become very popular in Germany as a treatment for circulatory disorders and now is available in all health food stores in this country. The medical profession here remains mostly ignorant of it.
Let me quote at length from the letter:
An 84-year-old friend of mine (I am 60) called to ask me if I knew anything about Ginkgo biloba. I said no, but I would do some research on it. My research led me to two books.… Then I did a little research elsewhere, coming up with a few things.
My own reaction to Ginkgo was so astounding that I became a walking advertisement for it. I started noticing activity on the third day I started taking it (one pill a day in the beginning). In a few days there was more activity. During the second week I began taking three a day, one with each meal. I believe it was the third week that I lost my depression and began feeling like the world was a wonderful place in which to live.
I began having more energy. In a six-week period I noticed more and more changes.… One of the most outstanding was when the Ginkgo reached my equilibrium. I had been walking with a cane because my gait was so unsteady. Suddenly, while walking in a store, I noticed that I wasn’t using my cane, and I had a longer stride, a steady stride. Not minutes later I ran into someone I knew and excitedly told her what had just happened to me. I was swinging my cane instead of using it to steady myself. I was so excited that I made a spontaneous rapid turn-around (something I hadn’t done in years!). (I know people must have thought I was crazy!) I was all smiles—as was the person I met!
I lost the pain in my legs and feet. I was regaining normal breathing action. Now, a year later, I have lost my night blindness (and have gotten my ophthalmologist interested in Ginkgo). My vision is better, and my hearing has improved immensely. (My TV is now on low sound rather than loud.)
I called and wrote to people I knew. People needed to know what was happening to me. Those who saw me after I was on Ginkgo were amazed.
A beautician had a lot of pain in her wrists from working with her hands so much. After listening to me she began taking Ginkgo and claims she not only has eliminated her pain but also sleeps much better. A woman in her late 40s could rarely get out of her house, and when she did, she needed to have a wheelable can of oxygen with her and be using it all the while she was out. Now she uses the oxygen very little—and is able to go many places. This shocks a lot of people who know her and her background.
I have TMJ (temporo-mandibular joint) problems—or I should say I did have them. Suddenly I no longer suffer from the pain! It had to be Ginkgo! It just had to be! I figure as long as I am on Ginkgo I’m not going to be bothered by it. Even the clicking sound is gone!
I have a 94-year-old mother in a nursing home and this year she changed doctors.… The new doctor was agreeable to Mom taking Ginkgo if I would pay for it. I certainly was willing to do that.
The last Wednesday of January 1994 this doctor okayed the Ginkgo. He allowed her only one pill a day. I wasn’t concerned about that since I had seen the 84-year-old woman who originally talked to me about Ginkgo do amazingly well with only one pill a day!
Mom started with Ginkgo the very next day. From Thursday to Sunday she changed amazingly! She was no longer depressed. She was happy. She was filled with life. Her voice volume had changed from a weak, soft voice (you could hear illness in its tone) to a strong, solid voice. I could feel electricity in that room between us! I was so happy to see her changes and she was thrilled to feel so much better! She also had a very miraculous improvement in her hearing! This placed her life in an entirely new category! Previously she walked in her own little world—not being able to hear others speak unless they yelled loudly (and few bothered to do that), and not being able to think clearly (short-term memory loss, confusion, anxiety, etc.)….
Suddenly she was hearing! For the first time she wanted to know how to fix her hearing aid! And one day she started talking to the people at her dining room table—something she had never done before!… It was obvious that her short-term memory loss was improving.… Her hemorrhoids also have improved. I expect a lot more things to improve.…
IT IS SO WONDERFUL TO BE ABLE TO FEEL LIFE AS IT SHOULD BE FELT—BE WILLING TO BREATHE AND ENJOY LIFE AS IT SHOULD BE ENJOYED! A PERSON JUST DOESN’T WANT TO STOP!
A man I know took one Ginkgo a day for approximately six months. He suffered from ringing in the ears. At six months he lost the ringing. He quit the Ginkgo. The ringing returned.
I believe it is necessary to continue taking Ginkgo if you intend to retain any of the benefits it offers. For those who suffer greatly it certainly is worth the cost! Far too many people feel that life isn’t worth living. I wish I could reach them all and tell them the wonders of Ginkgo!
This letter is a classic example of a testimonial to a health product. As such it would likely be dismissed by most medical scientists, who tend to drop all testimonials into wastebaskets labeled Anecdotal Evidence. In medical usage, “anecdotal evidence” means “of no scientific value or importance.” I take a different view of this material, and I am interested in why so many doctors have a hard time with it.
I suppose the simplest answer is that doctors and scientists do not like to be made to look like fools, and they sense danger in endorsing products or techniques whose claimed effects may turn out to be false or unprovable by controlled experiments. But it is equally foolish to ignore testimonial evidence, because it may suggest directions for experimental inquiry as well as provide clues to the nature of healing.
Many scientists reject testimonials out of hand on the assumption that the information is false, that people are either deluded or have simply made up the stories for one reason or another. The essence of good science is open-minded inquiry, so would it not make sense to try, at least, to verify the stories? My experience, overwhelmingly, is that whenever I have met and interviewed persons who have written testimonial letters to me, I have found no reason to disbelieve them, although I may not agree with their interpretations of their experiences. For example, I believe the writer of the letter quoted here experienced the positive changes she reports in her own health and the health of relatives and friends. I am not sure I agree with her statement that “it had to be Ginkgo! It just had to be!”
Science is the orderly gathering of knowledge by methodical inquiry and experiment, but where do you get ideas to inquire about or experiment with except through your experience of the world around you? Experimenting blindly, without starting from reasonable hypotheses suggested by experience, often wastes time, money, and effort. I became interested in Dr. Fulford and through him in cranial osteopathic theory and practice as a result of paying attention to testimonials about his work. Testimonials have led me to discoveries of other useful practices as well.
Some years ago I got a letter from a man in California describing remarkable experiences with a preparation of an herb called bloodroot, which he said miraculously dissolved moles and other growths on the skin, including, in at least one case he had witnessed, a malignant melanoma. He urged me to order the product from an old man in Utah who prepared it, and to experiment with it. I did order it (it was quite inexpensive), and shortly afterward a container of oily, blood-red paste arrived in the mail with no instructions. I went to my bookshelf to read about the plant.
Bloodroot is a small woodland herb, Sanguinaria canadensis, native to the North Central United States and Canada. Its taproot exudes a bloody juice, which probably inspired Native Americans to experiment with the plant as a medicine. Bloodroot was one of the most popular herbal remedies among Plains Indians and the European settlers who came later, used internally for sore throats and respiratory ailments and externally for growths on the surface of the body. The plant fell into disfavor in modern times with the demonstration that it was toxic: taken internally, it interferes with cell division and may promote mutations and cancer. The Food and Drug Administration has it on a list of most dangerous herbs. But I was able to find a number of references to its peculiar ability to dissolve abnormal growths on the skin without harming normal tissue, even to dissolving some breast cancers that had eroded through the skin, in the days before current cancer treatments were available. As a topical application, it seemed safe.
Since I had no immediate use for the paste, I put it in my refrigerator and forgot about it. I only remembered it six months later, when I had to make a decision about veterinary treatment for my dog, Coca, a female Rhodesian ridgeback, six years old and in good health except for a growth that had developed on her right side, near the shoulder. It had started as a black skin tag but had steadily enlarged until it was now the size of a marble and looked like a little black cauliflower. My vet told me it should come off. “These things can turn into melanomas,” he said. Taking it off would mean putting the dog under general anesthesia, which I did not want to do, since general anesthesia is a risky procedure, more so in dogs than humans. I did nothing, and the tumor kept growing.
Then I remembered the container in my refrigerator. Here was a perfect opportunity to test the power of bloodroot. I smeared a thin coating of the paste over the growth, and repeated the application every morning for three days. On the fourth day, when I called Coca over for the treatment, I was alarmed to see blood running down her side. The tumor had turned grayish and seemed to be separating from the skin, leaving a gaping wound underneath. I stopped applying bloodroot, cleaned the area with hydrogen peroxide, and resolved to keep an eye on the area. Two days later, the whole tumor, then whitish gray, fell off, leaving a raw, circular area that quickly healed over. The end result was a perfectly circular, slightly depressed area of skin, with no trace of tumor. The bloodroot had removed it more neatly than one could have done with a scalpel. Later, hair grew over the spot, concealing it completely. I could not have asked for a better outcome, especially as the dog had showed no signs of discomfort.
So much for my animal trial; I was ready to go on to humans. Shortly afterward a friend came to visit who showed me a mole he was worried about on his chest. His name is John Fago, a photographer, who had lost a leg to bone cancer some years before. He had been an avid downhill skier before the operation and now was an avid and very skillful one-legged skier. Statistically, John’s chances of being cured of his cancer were excellent, and he was careful to follow a lifestyle that increased them even more. Still, he was understandably nervous about strange growths. This one was a pigmented mole that had been enlarging. When I told John about the bloodroot cure of my dog, he did not hesitate. “Let’s do it,” he said.
Unlike my dog, John had no coat of fur, so it was easier to watch the process. On the second day of applying the paste, the skin around the base of the mole became inflamed, an obvious immune reaction, and John said it was quite sore. On the third day, the mole turned pale and began to swell. On the fourth day, it fell off, leaving a perfectly circular wound that healed quickly. Later I asked John to describe his experience to a group of medical students. He did so, with the result that I began getting requests for nonsurgical removal of moles. Over the years, I have given out bloodroot paste and instructions on how to use it to a number of medical students, and the outcomes have been consistent and satisfactory. The most recent was a young woman with a large mole at the collar line at the base of the neck. A dermatologist wanted to take it off, but his description of the size of the incision he would have to make put her off, and she knew that healing would be difficult because of the location. She asked me if I knew any alternative to surgery. Bloodroot solved her problem. “It got pretty scary-looking on the third day,” she told me afterward, “but I remembered your description of what would happen, and I tried not to worry. Now the mole is gone completely, and I think it’s a much better job than the dermatologist could have done. I’m amazed.”
So here is an example of a discovery made by paying attention to a testimonial. I would hope it would inspire scientific inquiry into the mechanism by which bloodroot is able to stimulate rejection of abnormal tissue and into possible applications of it for treatment of growths other than moles.
Talking about herbal cures with doctors is particularly difficult because they have no training in medical botany and because the subject is highly polarized, with some authorities claiming that the use of plants in medicine is not only unscientific, being based on purely anecdotal evidence, but also dangerous. This is an uninformed position. Not only do many pharmaceutical drugs in current favor come from plants; there is quite an active effort today to study traditional plant remedies by the methods of modern science. In general, herbal medicines are safer than pharmaceutical drugs simply because their active constituents are diluted by inert material and modified by secondary components. On the other hand, manufacturers of herbal products often make unsubstantiated claims for them in order to sell their wares in a competitive and largely unregulated market.
Take Ginkgo biloba. Dozens of scientific articles about its chemistry and pharmacology, based on both animal and human experiments, have appeared in good, peer-reviewed journals, although the journals are not ones read by American physicians. (I cannot think of one physician I know who reads Planta Medica, a German journal and one of the best.) If you will review the hefty technical literature on ginkgo, you will find experimental evidence that it increases blood flow throughout the body, especially in the head. It has been shown to be an effective and nontoxic treatment for disorders of hearing and equilibrium due to impaired circulation to the ear and for deficits of memory and mental function due to impaired blood supply to the brain. Its lack of toxicity is in great contrast to pharmaceutical drugs used to treat these conditions.
The known actions of ginkgo extract are consistent with some of the favorable results reported in the testimonial letter from the woman in Chicago, but the effects she says she has experienced go beyond those known actions. Besides, the dose she was using is low. The effective dose range is two tablets of the standardized material taken three times a day. Even with that, patients are advised to be patient; the beneficial effects of ginkgo usually do not appear before six to eight weeks of continuous usage. So even if we accept the stories as true, there is a question about the assignment of cause and effect. Did ginkgo cause the beneficial changes?
This question raises a thorny issue that leads even more doctors to throw testimonials into wastebaskets. It is well known that belief in medicines can cause favorable outcomes even if the medicines are ineffective. This is the placebo response, which most doctors dislike because it muddies their experiments and seems inherently unscientific from the point of view of the biomedical model. I regard the placebo response as a pure example of healing elicited by the mind; far from being a nuisance, it is, potentially, the greatest therapeutic ally doctors can find in their efforts to mitigate disease. I believe further that the art of medicine is in the selection of treatments and their presentation to patients in ways that increase their effectiveness through the activation of placebo responses. The best way to do this as a physician is to use treatments that you yourself genuinely believe in, because your belief in what you do catalyzes the beliefs of your patients.
Unfortunately, this view of placebo medicine is very much out of fashion today. Most doctors want nothing to do with placebos, favoring instead “real” treatments that work through identifiable biochemical mechanisms. They also like treatments that produce very specific effects (“magic bullets”). If a drug begins to work in too many different conditions, most doctors lose interest in it, because they think lack of specificity means lack of an underlying mechanism. In other words the drug could be—perish the thought!—merely a placebo.
I might mention that this way of thinking is unique to Western medicine. In traditional Chinese medicine, drugs, which are mostly herbal, are classified into three categories, called superior, middle, and inferior. Inferior drugs are those with specific effects in specific conditions, the magic bullets that are Western medicine’s highest therapeutic ideal. Middle drugs have broader powers because they strengthen body functions. Superior drugs are the tonics and panaceas, those that work for everything. Ginseng is an example; its Latin name, Panax, comes from the same root as panacea, meaning “all heal.” In the Chinese conception, superior drugs work by stimulating the defensive functions of the body, making it more resistant to assaults of all kinds. These drugs are not toxic, not weapons against specific diseases; but by increasing resistance, of course they work for everything.
This short digression into medical philosophy and the differences between Western and Eastern medicine is meant simply to point out the many reasons why most scientifically minded doctors in this country would ignore testimonials such as the one above. In short: they tend to disbelieve the stories without attempting to verify them, possibly out of fear that someone is trying to put something over on them; they are unwilling to endorse (or even consider) types of treatments falling outside their area of experience, such as herbal remedies; and they are reluctant to put cause-and-effect interpretations on anecdotes of this sort because they fear the reported benefits, even if true, may turn out to be “nothing more” than placebo responses.
Over the years that I have been writing and speaking in public I have received hundreds and hundreds of testimonials. For every testimonial letter that has come to me I have heard dozens more stories that were not written down. In these accounts patients have sung the praises of an astonishing variety of therapies: herbs (familiar and unfamiliar), particular foods and dietary regimens, vitamins and supplements, drugs (prescription, over-the-counter, and illegal), acupuncture, yoga, biofeedback, homeopathy, chiropractic, surgery, prayer, massage, psychotherapy, love, marriage, divorce, exercise, sunlight, fasting, and on and on. I collect this material, save it, and take it seriously. In its totality and range and abundance it makes one powerful point: People can get better. More than that, they can get better from all sorts of conditions of disease, even very severe ones of long duration.
Like my colleagues, I also question the simple cause-and-effect interpretations placed on these reports and hesitate to endorse products and practitioners; but unlike most of them, I do not throw out the reports. Testimonials are important pieces of evidence. They are not necessarily testimony to the power or value of particular healers and products. Rather, they are testimony to the human capacity for healing. The evidence is incontrovertible that the body is capable of healing itself. By ignoring that, many doctors cut themselves off from a tremendous source of optimism about health and healing.