Vanishing Point Herbs

This is a literal vanishing point:

By Jakec - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=34599188

(Incidentally, who would want to be attributed for a photo which is dead easy to acquire or take like this?  It's not even a proper vanishing point).

The vanishing point is the location in an image using perspective where parallel lines appear to converge to meet, as I expect you know.

Ben Elton used the term "vanishing point" metaphorically in STARK to refer to a situation where the planet could no longer support human life without an artificially constructed environment.  This phrase stuck in my head and it occurred to me that there are various situations which this could apply to.  For instance, there were claims in Germany a few decades ago that it wasn't safe to breastfeed because of the level of dioxins found in breastmilk, and since breastfeeding could be seen as fundamental to human survival - anything else is an  artificial intervention even if necessary, and I say that as someone both of whose children were born by C-section so I'm not being judgemental here - if dioxins were at such a level in the environment, it means you get into a "damned if you do, damned if you don't" situation.

So far, so depressing.  However, I'm not saying this is actually true, just that the concept is useful.  Also, I am aware that this is about to be the second post in a row on this blog which is arguing against using particular herbs medicinally.  Here we go then.

You will recognise these:

as hops, Humulus lupulus.  Since I'm from Kent, hops are as familiar to me as apples and they were ubiquitous in my childhood.  When I was about six, I boiled up a decoction in the back garden from hops I found lying around on the road outside my house.  This is the kind of incident you look back on with hindsight so you can say to yourself "See?  Even back then I was always going to be a herbalist", but in fact it's far from inevitable that that was what I was going to do with my life and if I'd done something else, some other incident would come to mind which would illustrate why I was always going to be a hairdresser or something.  I could go into this in more detail but it doesn't really fit this blog.

Hops are of course related to Cannabis and it's therefore hardly surprising that they're psychoactive.  They're also related to stinging nettles, which are quite similar to Cannabis in appearance and uses.  Stinging nettles are a useful source of fibre for textiles, just as hemp is for canvas, hence the name.  Anyway, back to hops.  Cultivated hops are generally bred for bitterness so that they are more efficient in flavouring beer.  In the past, other herbs were used for that purpose, such as rosebay willowherb, Epilobium angustifolium, which as you can see from this image is clearly related to fuchsia (which I used to eat by the way):

By kallerna - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=7339651

Breeding anything to enhance one feature tends to do so at the expense of others, so hops bred for bitterness are good liver tonics, being bitter, but not necessarily as good for their other purposes.  This generally means that 

Until today, I have never used hops medicinally as a herbalist.  At first sight, they seem to be pretty groovy in various ways.  They're bitters, phytoestrogenic, sedative and help sleep and anxiety, so on the face of it they sound pretty good, but there's a fairly big caveat among all this.  They are contraindicated in depression because they make it worse, supposedly, and in overdose they have a paradoxical effect, like many other drugs, of causing the very symptoms they relieve in therapeutic doses.  Since insomnia is often connected to anxiety and depression, and since there is probably a strong link between the brain chemistry of anxiety and that of depression, that effectively means that for the most part, hops are prima facie pretty useless in those respects.  This is what I mean by a vanishing point herb.  The herb is supposedly useful for the very conditions which people with problems for which it's contraindicated tend to have as well as those conditions, so it's neither use nor ornament.

I am prone to depression and anxiety, so if I wanted to test hops in this respect, I would make a good subject provided I had sufficient perspective to recognise that my mood might be contributed to by the action of those herbs.  I have a hypothesis about hops I wanted to test.  I suspect that they are not across the board depressant, but have actions which are mistaken for depression, in two respects.

Tearfulness can easily be mistaken for depression, and a lot of the time depressed people might cry a lot too.  However, crying is also, to my mind, often the excretion of emotion - catharsis.  If you can cry, it's a safety valve which actually helps you to overcome depression.  The analysis of the composition of emotional tears, as opposed to the kind of tears you get from, say, cutting onions, reveals that they are different.  In particular, for some reason they are high in manganese, to the extent that they have been known to stain contact lenses pink, which you might think would help.  Here is an example of a manganese compound, manganese (II) chloride:

I think that it's possible that tearfulness has been mistaken for depression here, because hops are phytoestrogens, and oestrogens can make it easier to cry.

The other reason I think this may have been misjudged is that it may well make many people's depression worse, but like many drugs this reflects sexism in the testing process.  This happens a lot in pharmacology when drugs are tested on exclusively male animals.  The majority of these animals are also of course non-human, which doesn't help either, but women experience more adverse drug reactions than men do, or at least report them.  Since women get sick and men die as well, this may not be so, but it would certainly make more sense if it turned out the difference was due to inadequate testing on slightly more appropriate subjects, viz. female non-human animals.  Obviously they do go on to test them on humans but women are also under-represented in clinical trials.  The reason for this is that there is more short-term temporal variation in female physiology than in male, or at least this is understood to be so.  This fact has also, incidentally, been used to explain man flu.

When men are given an oestrogen, it apparently makes them depressed, among other things, all negative.  When women experience an increase in oestrogen levels, it may or may not cause depression, depending on various factors including what oestrogens are involved.

I have just taken around 50% more than the highest recommended dose of Humulus lupulus and I am clearly not feeling down in any way right now even though I have a cold, was already tired and there are various depressing things happening in my life.  I think this suggests that the female brain is not depressed by hops, but the male is, or at least that the male brain is more depressed by them than the female one, and the reason people think it is may be sexist drug testing and misinterpretation of "symptoms" which are not only not indicative of depression but aren't even problematic, again due to sexism.

Back to the idea of vanishing point herbs though.  Here's another one:

By MPF - Own work, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=1023226

These are juniper "berries", which are of course used in gin, which has itself been used medically in a manner I won't go into here.  Juniper is an unusual plant in several ways.  Firstly, human food and by extension medicine from the vegetable kingdom is generally from flowering plants, which reflects our evolution as primates after the appearance of that type of plant.  Secondly, this is an example of a non-flowering plant which seems to produce fruit.  A closely related plant I do use a lot is yellow cedar, Thuja occidentalis, which is not eaten as food as far as I know.  Juniper is also, again as far as I know, the only example of a spice from a non-flowering plant.

Juniper "berries" are not berries but cones, like pine cones.  Conifers don't really produce fruit as we understand it, although the distinction can be rather academic as they clearly do produce plant organs which contain seeds, as with yew berries.

Juniper berries are diuretic because at therapeutic doses they induce mild inflammation in the kidneys, which increases blood flow to the kidney and therefore, ideally, more urine being filtered out by the kidneys.  That said, one of the important functions of the kidneys is to reabsorb urine rather than produce it, which sounds counterintuitive until you realise that damaged kidney tubules tend to produce excess urine because their epithelium has healed to less specialised epithelium.  There are enough reasons for diuresis, to be sure, but if there are already kidney problems it generally doesn't make sense to me to do something else to irritate them.  Consequently I never use juniper berries, mainly because of the same "vanishing point" effect as hops, except that this time it doesn't look like it's rescued by the possibility of sexism in the research.  Again, it's an example of a herb whose use is often ruled out by the fact that it may cause problems for the very type of person it's meant to help.

Apart from juniper and hops, I can't think of other examples of "vanishing point" herbs.  On the whole, the herbs I use I believe in, but cognitive dissonance would lead me to do so, wouldn't it?  Another question is of which herbs are actually completely ineffective because they don't do very much, and I'm pretty sure I can think of an example of that too, but if I mentioned it that would take away the placebo effect, so I won't be doing that!

Endangered Herbs

One enquiry or request I get a lot is for Hydrastis canadensis or Goldenseal, which is this plant:

It's in the Ranunculaceae, and I'm not terribly keen on using plants in that family, which also includes buttercup and black cohosh, because all of them are somewhat poisonous.  Paracelsus established an important doctrine of toxicology, which was that it wasn't the poison that was poisonous but the dose.  With the exception of carcinogens, there are safe doses of all toxins, and since they are toxic because of their effect on the body it often turns out that they have useful actions at lower doses.  For instance, cayenne or chili pepper is a useful circulatory stimulant but if you drank two litres of Tabasco sauce it could kill you because it would cause so much vasodilation that the heart wouldn't be able to push blood round the body any more.  The ratio between the dose of an agent needed to kill someone and the dose needed to have a positive effect is called the "therapeutic index", and in herbalism at least, the ratio should be at least ten to one.

Traditional Chinese Medicine and contemporary Western herbalism differ in this respect because the plant remedies used by the former tend to be fairly toxic, or perhaps "active", by the standards of the latter.  Western herbalism nowadays tends to use the likes of reflex actions brought on by taking the remedies more, such as the bitter, sour and sweet reactions and the soothing expectoration of a mucilaginous herb which soothes the digestive and by extension the respiratory system.

Consequently I'm not enormously happy about using herbs which are poisonous in even fairly small doses.

By H. Zell - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=8950508

Another example of this is Cimicifuga racemosa, now known as Actaea racemosa, black cohosh, which when I take it just somehow feels toxic and damaging, and which is in the same family.  Of course a feeling is not enough to base such a judgement on, but throwing up after taking it and spending the next day in bed feeling like death warmed up is, particularly when I am not generally a puky person. It'll be no surprise that it's also in the buttercup family.

Even so, it's not the toxicity of Hydrastis canadensis which bothers me.  There are plenty of good herbs which are fairly poisonous but still useful, such as deadly nightshade, It's a frightening sounding herb and I've never used it myself but it's potentially good for all sorts of things, in tiny doses of course.

My objection to goldenseal is not its toxicity but the fact that it is rare, endangered and harvested unsustainably from the wild.  Its rhizome, the part used, grows about an inch a year, and it's difficult to cultivate.  This more or less means it has to be uprooted and it won't grow back.  All of its actions are replaceable by much more common and more sustainably sourced herbs.  

It's well-known for containing berberine, the substance whose structural formula is depicted above, which is naturally also in barberry - Berberis vulgaris:

Berberis species, of which two are used in medical herbalism, are more distantly related to buttercups but still in the same order.  It's so common I can take a rather blurry photo of another species, Berberis aquifolium, from where I'm sitting now:

This is of course called Mahonia rather than Berberis vulgaris, and the vulgaris part of the name means common, but both species are pretty common, easily cultivated and if you want to go down the route of thinking that isolated active constituents are all that herbalism is about, there's your berberine.  Berberine is antifungal, lowers blood glucose (along with a load of other things which do the same, notably onions) and can correct cardiac arrhythmias, among other things.

I never use Hydrastis canadensis because it's endangered.  Whether it's useful or not, it can't be used ethically or prudently.  It's mined from the environment in the same way as the likes of cod are overfished, and it's not responsible to use it.  This is what I tell everyone who asks for it.

That's another thing of course:  people ask for it.  I am of course entirely open to the idea that just because I happen to be a herbalist, even an experienced one, doesn't mean I know what's best for my patients, but this is the usual story of people looking something up on Google and deciding it's what they need from biassed write-ups on sites trying to sell them stuff.  That's not what herbalism is about.  Whereas it's important to respect the opinions of patients, I would respect them a whole lot more if those opinions were based on their personal experience or the experience of people with broader first-hand knowledge rather than something they read on the internet.  I do have a great deal of respect for supposed "lay" opinion, and in some ways a herbalist is just a nexus for tips picked up by her patients that she can pass on to other patients, but those tips need to be reliable and properly tested and checked.

I've mentioned this issue before, but it bears saying again.  Hydrastis canadensis, like many other rare herbs from distant sources, may be a "Veblen good" in economic terms.  A Veblen good is a commodity whose price increases with its price:  the more expensive it is, the more people want it.

By Periodictableru - Own work, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=9774375

  Another example of a Veblen good is platinum.  All the platinum that has ever been mined in history fused together would probably be just big enough to make into a solid armchair-shaped and -sized block.  Consequently it's sought after and makes good jewellery.  If you are going to buy someone a platinum wedding ring, the more expensive the better.

Hydrastis is another such good, and there are plenty of others in herbalism.  Veblen goods include status symbols and in the case of herbalism, there is actually an argument for going along with the idea of Veblen goods because the more expensive medicine might have a stronger placebo effect.  However, it would also be nice to be able to uncouple the placebo effect from the materials and procedures associated with them and just use it as such.  Then again, the efficacy of herbal remedies does exist besides their placebo effect and herbs generally are ideally free from the commodification and intellectual property issues associated with pure drugs.  Consequently, when people want Hydrastis I will always say no, because wanting Hydrastis is entirely foreign to the spirit of herbalism at its best.

I was going to say something about multi-level marketing at this point but that can wait for another day.

Gravity Waves

It was announced yesterday that gravity waves had finally been detected.  This surprised me since I understood them to have been picked up in 1969, but presumably that was a false alarm.  

This reminds me of the "detections" of planets in the 61 Cygni and Barnard's Star systems which occurred about the same time which turned out to be the telescope lenses getting polished and put back wonky. Nonetheless it may be the real deal this time.

One of the surprising things about the coverage in the media was that someone said that even the simplified version was hard to follow.  This puzzled me.

Just briefly, the "chirp" detected by LIGO, a pair of detectors in North America, seems to have been the result of two black holes, each thirty times the mass of the Sun, colliding with each other at half the speed of light a billion light years away. The conversion to sound I heard, which was also speeded up, reminded me of two billiard balls bouncing off each other.  Bearing in mind that space and time are warped by mass, massive objects make dimples in space like the feet of pond skaters or other small objects floating on still water. If two such objects collided, ripples would result and those ripples are gravity waves. Objects which are in the path of gravity waves will shrink and stretch very, very slightly, but this is hard to detect because rulers, that is measuring devices, of most kinds will also shrink and stretch go the same extent, so they're hard to measure. LIGO is the most sensitive measuring device humans have ever made and is affected by such things as logging many kilometres away and cars bumping along nearby roads, so they are in remote areas and there are two because this allows errors to be cancelled out. It was expected that the waves, when first detected, would be hard to pick up against the hubbub of everything else which was going on at the same time, but it turns out to have been really clear.  They use a split laser, and I am going to take a guess here that they use interferometry although I don't know. They are V shaped devices several kilometres long.  Here's one arm of the Hanford LIGO:

By Umptanum - Self-photographed, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=2591541

Gravity waves are interesting for several reasons. One is that they were predicted to exist by Einstein, so they confirm further the theory of general relativity. Another is that almost all astronomy has been carried out using electromagnetic radiation up until now, that is, the likes of radio waves, X-rays and light, although neutrinos and various types of cosmic rays have also been used.  Unlike electromagnetic radiation, gravity waves can get through anything, so the dark dust clouds which, for instance, make it impossible to see anything on the other side of the Milky Way or beyond that to the edge of the observable Universe, will not be a problem. Also, it will be possible to see things which happened !any aeons ago soon after the supposed Big Bang happened.  Also, just as there are different radio frequencies and colours of light, there may also be a range of gravity wave frequencies. However, really good gravity wave detectors would have to be built in space where they can be huge and there will be less interference from stuff happening on Earth, although there are plans to build a few more on this planet first.

All that seems quite simple to me, but apparently not to other people, and this is where my problem emerges. Although I am unemployable for reasons I don't understand but appear to involve getting far enough in the application process to get an interview and may involve my tendency to spread myself too thin, I have no trouble getting all this and I do have trouble understanding why other people don't get it so easily. I rejected the notion of intelligence long ago because it seemed elitist.  In any case it does seem to me that spending enough time concentrating on something will lead go most people understanding it, or having it explained in the right way will and so on.  The world of thinking is not plagued by the same kind of cantankerousness and resistance as the physical world is, so there is nothing similar to dexterity or physical strength in it which makes things in some way ultimately and intractably hard to understand.  Consequently, when someone doesn't grasp something like this, I see the issue to be just that they haven't spent enough time or energy on trying to. This kind of thing does apply to me sometimes in the world of intellect. For instance, I simply can't be bothered to put in the work required to discover how sports or Gadhlig work, and so I don't. If I was interested enough or it was for some other reason important to me to get to grips with them,  I would do so. 

By Olympics_2012_Women's_75kg_Weightlifting_(2).jpg: Simon Qderivative work: Materialscientist - This file was derived from  Olympics 2012 Women's 75kg Weightlifting (2).jpg:, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=24170873

On the other hand, I am never going to be strong enough to lift a seventy-five kilo weight over my head or run 100 metres faster than Usain Bolt. Those are different kinds of problems that are intractable to almost anyone.  Knitting, for me, also falls into that category.

This may of course merely be due to the fact that I don't recognise my own strengths and weaknesses.   However, it's also substantially to do with the time I've spent doing particular things which are unusual, and the age at which I did them has made them second nature to me.  It may also be that, given that I don't know my strengths and weaknesses, I don't really understand it at all but only think I do.  This is the problem with being isolated from an academic community, and it also suggests that the idea of some kind of superhuman genius working or thinking in isolation is incoherent.

There is nothing wrong with concentrating on other things than the likes of astronomy, theoretical physics, philosophy, comparative linguistics and so forth.  Being able to do other things is very useful and it is in fact one reason I decided to become a herbalist.  I wanted to be able to do something practical and useful.  However, it's also a little disturbing that people can't seem to understand something as simple as General Relativity.  It's not like quantum mechanics, which most people who kind of understand it say that if you think you understand it you probably don't.  General Relativity can be summed up quite straightforwardly as "Spacetime tells matter how to move; matter tells spacetime how to curve," as John Archibald Wheeler, who worked with Einstein, put it.  These things have a kudos to them which makes them seem special or intellectual, like rocket science, which is again not really that hard.  

Brain surgery, on the other hand, really is hard because it involves fine motor skills.  I made a model of the human brain about as detailed as the above picture when I was nine, including the sulci and gyri, i.e. the crevices and bumps, which was immediately thrown away by my teacher at the time of course, but that's not the point.  I have some cognisance of the anatomy of the human brain, meaning that in theory I might know which bits of an exposed brain in front of me do what, but actually cutting into one with a scalpel or whatever is of an order of difficulty akin to the dizzy heights of knitting.

There is also such a thing as emotional intelligence.  I don't know whether that applies to me or not for the usual reasons.

Cutting through all that thicket of overthinking though, I am confronted with at least the possibility that I may have an aptitude for understanding gravity waves or whatever, and that other people tend to lack that aptitude.  I find that though very worrying, because it might mean, for example, that there is something out there vital to the survival of the human race which the general population really can't understand sufficiently to take into consideration or take action to maximise the chance that we will in fact be able to continue to exist.  It's a fact that gravity waves are dead easy for me to comprehend, but it's also a fact that people not comprehending gravity waves is about as hard for me to comprehend as it seems to be for them to grasp the original concept.  If this is true, and I would also want to point out that just as learning disability is not a character flaw, intelligence of the kind I am often seen as having is not a virtue either - apart from anything else it probably stops me from being gainfully employed, but if it is true, it makes me feel frightened and lonely.  It would mean that there would be a heck of a lot of stuff I couldn't share with anyone, for example, and that I would have great difficulty making myself understood.

Therefore, I am highly motivated to find a way to convince myself that this is either untrue or doesn't matter.  All of that stuff, to me, is more important than the apparently important scientific discovery I've been talking about.

I just really hope I'm stupid or ignorant, and those can be good things to be.

In It For The Money?

One of the more laughable but still understandable claims made for herbalism is that we're in it for the money.  The idea is that we are either deceived or con merchants, and that we are able to make a pretty penny out of it.

The more charitable version of this is that the majority of conditions get better on their own, so if they happen to improve while someone is taking a herbal remedy, that is fallaciously chalked up to success by us lot and we continue to deceive ourselves because of this kind of thing.  If there is a trajectory of health and illness like this:

then the right hand side of that graph is, financially speaking, the herbalist's friend.  The other half might also be fine if you can sell the idea of things getting worse before they're going to get better. In the meantime in this view, we deceive ourselves or others into thinking we're helping our patients.

Just briefly, this is not true, two pieces of evidence being that many patients only come to see a herbalist once they've tried everything else they can think of without success and that measurable findings such as peak flow, degree of cover by skin lesions, resting blood pressure and the like can be seen to improve after treatment.  However, I'm not here to argue for the efficacy of herbalism but to point out how laughable it is that we are in it for the money.

Several years ago, I took the rather brave step of publishing a summary of our accounts year on year in the newsletter for our professional body.  I had suspected for a long time by that point that not many people were making a living this way because of the nature of our figures, but was open to the possibility that it was due to our location in the country or some other factor.  I was rewarded by a prolific response from other herbalists which revealed that we were by no means an isolated exception to the rule.  Very few people make a living from herbalism, by which I mean that they fail to generate much of an income from taking consultations and prescribing medicine.  There are also rather few "pure" herbalists, so those who practice herbalism who are making a living may be doing so from other complementary therapies rather than herbalism itself.  That said, there may be a way of making a living from herbalism by other methods, such as running continuing professional development workshops, writing books or lecturing.  The problem with these, however, is that they take money from other herbalists or potential herbalists - students.  This would also be fine if there was a greater level of income from acquiring new skills and practices which would then increase income and success, but that isn't what happens.  What in fact takes place is that herbalists give other herbalists their money and continue much as before.

This is not necessarily a bad thing.  Herbalism is useful and rewarding, and also fascinating, so in an ideal world there is no reason not to continue with it.  What needs to be borne in mind, however, is that it can only very rarely be a source of sufficient money to live on, and therefore herbalists either have to do something else to support themselves or have a means of support from somewhere else.  I would like to stress that this need not be a bad thing.  If we have no prospect of making enough money to live on, reducing reliance on that source of income means that there is no temptation to treat patients unprofessionally as a way of maximising profits.

A later response to my letter was a Master's thesis on the public profile of herbalists, which involved a survey at an NHS health centre among a randomly selected group of patients.  Something like 2% of the sample were aware of what a herbalist does.  Many people confused it with homeopathy and even those who did know what a herbalist does usually mixed up Western and Chinese herbalists.  When most people think of herbalism, they conceive of it in terms of dried herbs, pills and potions bought from chemists or health food shops and never even imagine there are professional herbalists.  The mark up on the herbs sold to the public over the counter is many times that of the herbs sold by a professional herbalist to the public and the quality is far lower.

It seems to me that the reason people think we're making money hand over fist is that they think it's about the expensive and relatively ineffective remedies sold in shops.  There may also be some confusion with Traditional Chinese Medicine, Ayurveda and the like.  There is a psychological phenomenon known as the Dunning-Kruger Effect where those who are relatively ignorant of a subject think they know a lot more than those who have more knowledge of it.  Education often reveals how little one knows about a subject.  Since the people concerned know little to nothing of herbalism, they suppose they know a lot more than the herbalists.  For instance, and this also occurs in home ed, they presume they know what it is and don't need to be told.  Experts, what do they know, eh?

However, there is more than this and it can be applied more widely than to the alleged snake oil vendors such as myself.  Specifically, there is a tendency to pad out herbalism courses with irrelevant and poorly applicable subject areas and also there is a tendency to over-sell the courses as vocational.  However, this is not a feature specific to herbalism or complementary medicine.  It's actually something which happens across the board.  Performing and fine arts courses are said to be other examples.  There are financially successful results there, yes, but they are often the exception rather than the rule.

Another, again entirely true, allegation made against complementary medicine courses is the secrecy of the course content.  The content and syllabus is not available to the general public.  This is a very common practice.  I tested this by looking at the syllabi of courses such as engineering, physics and psychology from Russell Group universities, and found that there was a similar degree of secrecy.  Some higher ed institutions do publish their entire course content online, for example MIT, but this is because they profit from the likes of good physical facilities, the opportunity to network and good staff-student ratios.  It is an indictment, but not of complementary medicine so much as the profiteering of universities and their ilk.

One thing that bothers me about all this is that the people who make this allegation often see themselves as sceptics.  They are sceptical of what they see as complementary medicine.  They rightly criticise the nature of complementary medicine course content but fail to note that the same criticisms, and they are serious, apply across the board in many universities and many disciplines.  They also assume they are well-informed about something about which they are not, a well-known cognitive bias, and yet they are apparently unaware of that cognitive bias when they are very ready to accuse us of the likes of confirmation bias.  This bias leads them to think we're raking money in from the gullible public when in fact nothing of the kind is taking place.  It's not easy to make a good living out of anything if you haven't already got some kind of fiscal or social capital behind you and the same is true of herbalism as it is of all sorts of other areas.  They also fail to mention the dubious ethics of taking the cash off other people acting in good faith to improve the lot of others in a way which accords more with their conscience.  Moreover, they seem to be completely unaware that they are doing any of these things.

Anyone who is in this for the money is going to be seriously disappointed unless they're extremely lucky.  I am aware that like everyone else I have cognitive biasses, although most of the time I don't know what they are.  People who describe themselves as sceptics seem to be relatively unaware that they too are subject to these limitations.  They are in fact not sceptics.  Sceptics, usually spelt with a K because they are apparently reacting to American religious fundamentalism or copying that reaction in a different cultural context where it's less of an issue and therefore spell it in the American way, are in that narrow sense people who suspect opinion stated as facts.  In the broader sense of people who believe knowledge is rarely possible, I am a sceptic.  It can be a lot easier to perceive the opinions of others as factual than it is to recognise your own opinions are those, not necessarily facts.  Moreover, there is an emotional element to truth which they seem to gloss over entirely.  Suppose your house has burned down.  You might say "I know my house has burned down but I can't believe it", because you don't want to believe it.  These kinds of bias are healthy and part of most people's mental make up, and it doesn't make sense to deny that they exist and form an important part of thought.  Denying them is not intuitively a good thing.

Therefore, no, we are not in it for the money, and the main reason people think we are is that they know nothing about herbalism, don't even know that they know nothing, and don't want to be less ignorant than they currently are.  In the meantime, we have very tough lives which they make even worse by propagandising ignorantly against our good will and honest attempts to improve the lot of our patients.