The Apothecary's Garden: Navigating the Complex World of Medicinal Plants
The following interview was recorded for the Poor Proles Almanac podcast with guest Dr. Greg Susla, who's been a volunteer at the National Museum of Civil War Medicine since January 2011. He had received his pharmacy degrees from the University of Connecticut and Florida and completed a critical care pharmacy residency at the Ohio State University Hospitals. Dr Susla spent most of his career as an ICU pharmacist at the National Institutes of Health in Bethesda, Maryland, and volunteered his time at the ICU. Dr Sousla recently retired as the Associate Director of Medical Information at MedImmune in Maryland. Dr Sousla also oversees the management of the gardens at the National Museum of Civil War Medicine and the Pry House.
Andy:
Thank you so much for taking the time to chat with us. I know you've got an extensive history both in medicine and with your medicine garden project, so I'll let you introduce yourself and your work.
Dr. Greg Susla:
Thanks guys. I'm Greg Susla. I'm a pharmacist by training. I graduated from the University of Connecticut School of Pharmacy in 1980, and that's what started my interest in medicinal gardens. The university, or the School of Pharmacy, had a medicinal garden outside its building and I would wander through the garden and look at some of the plants in the garden and then see them as we were taught in class or see them in the textbooks that we're using. Then went on and spent most of my career as the ICU pharmacist at the National Institutes of Health, Bethesda, and Maryland, and then moved on to the pharmaceutical industry.
But about 10 years ago, I became a volunteer at the National Museum of Civil War Medicine in Frederick, Maryland, and they have three sites. They have the main museum on East Patrick Street in Frederick, they have the Clara Barton Missing Soldiers Office down in Washington DC, and then they have the Pry House on the Antietam National Battlefield, the Pry House was the center for George McClellan or his official area during the Battle of Antietam, where he and Jonathan Letterman, the medical director there with Potomac, actually commanded the battle. And I was talking to a museum staffer one day who was actually who had actually started probably a combination kitchen and medicinal garden on the grounds of the Pry House, and so I asked him one day if he wanted some help because I said, you know I have an interest in this. I'll be glad to help you. And after that, he moved on to graduate school and left the museum.
So in 2016, I talked to the museum people and said what's the status of the garden? They said, well, it's kind of fallen into disrepair. I said I'd be interested in taking it over and reconstituting it again. So in 2016, my wife and I and a couple of other museum people started working on the garden, and at that time, I think, we planned on about 10 plants. Today, we have about, I think, between 30 and 40, depending on which ones have survived the weather, the winter, and the varmints.
Andy:
Amazing work. You've had a pretty varied experience getting into this type of work. As somebody who doesn't have a medical background, I find it really hard to sift through the facts and fiction of what exists on the internet because you can look up any plant just about and it seems like somebody will say it has some kind of medicinal use, and that becomes really challenging. I guess how does your background in medicine guide that project in terms of what you wanted to plant in the garden?
Dr. Greg Susla:
So, to start off the plants I selected, initially, somewhat naively, I wanted to pick plants that would have been in the mid-Atlantic area in the 1860s, the time of the Civil War. So I talked to a gentleman who runs Strictly Medicinals out in Oregon, who's a great source of medicinal plants, and said this is what I want to do; what should I grow? And he said that's a great question. I'll call you back. And he called me back in about a week or so with a list of plants. Then I realized that some of the plants we had in the garden, like ephedra, had gone back 5,000 years.
Senna goes back 5,000 years, and there was nothing unique about the mid-Atlantic area in the mid-1860s. So the next place I went to was period medical and pharmacy textbooks. So the United States Pharmacopeia, the United States Dispensatory, some of the Materia Medica books that had the plants that I was interested in, that I could validate that they were in the official compendia of the time during the Civil War, that had some medical value, that those are the plants I would plant next. So the garden now contains the majority of the plants.
I can reference period medical and pharmacy textbooks from about the 1820s to about the 1880s, so many of these have a history going back thousands of years. But in the United States, these are plants that were recognized as clearly of medicinal value in the official compendia, and that's what I'm working with now. So when I write the column for the museum's website on the garden, I use period-correct textbooks describing what plants were used, how they were used, and describing them in the words of the 1860s.
Andy:
Yeah, that's something that I found on the blog a few years back when I was trying to figure out more about utilizing medicinal gardens and trying to find somebody who was actually both historically accurate and with some medical background, and I happened to find it, and it's something I've been checking on for the last couple of years. And then this project came up with the podcast and I was like, oh, I definitely have to reach out and see if I can get somebody that can speak to it on the podcast.
So I appreciate it very much. This is something I've been following for much longer than this podcast, so I was under the impression reading the blog that you've put together or the column. Rather, it sounds like this was probably one of the last official medicine gardens in the United States. Is that accurate?
Dr. Greg Susla:
No, there are actually a lot of medicinal gardens in the United States. If you look for them, you’ll find them; I don't think they're publicized or advertised. So, in Washington DC, we have the National Arboretum, and within the National Arboretum, they have a section that's a medicinal garden. If you go to the botanical gardens up in the Bronx, they have a section on medicinal gardens. Some of the old schools of pharmacy still have medicinal gardens.
So, one of the important physicians during the Civil War was Dr. Porche, who wrote a book looking at indigenous species in the South to use as alternatives to medicines that couldn't be obtained from the North.
Well, he went to the Medical College of South Carolina, which is now the Medical University of South Carolina in Charleston, and they have Porche's medicinal garden there, so you could go visit it. In Charleston, the University of Connecticut School of Pharmacy, where I went, put up a new building a couple of years ago, and they planted and opened up a medicinal garden about a year or so ago. So if you look for them, you're going to find them in various places.
Here, we have the University of Maryland Extension in Washington County, where Antietam is, and on the extension grounds, part of their garden is a medicinal garden. So if you look for them, you're going to see them. But you probably have to look long and hard to see who actually has one. But we're not alone. Ours is dedicated to a certain period. A lot of them are just general medicinal gardens, but you will find them if you look for them.
Elliott:
It does sound like these medicinal plants are. They are around in these gardens that people have constructed, but they are native to certain regions. Do you ever see them being reintroduced back into, I guess, like you know, more natural habitats, or do you see them only being used as medicines from this point forward, knowing that they could be useful as well as fatal?
Dr. Greg Susla:
So I think a couple of things. I don't think they're being replanted in a natural environment. If they are, I'm just not aware of that. I don't know a lot of medicinal gardens today, like the National Arboretum, our garden, and others.
They're really ornamental gardens. They're not really being used to harvest plants to extract drugs from them. Now, people who believe in this probably have their own backyard garden where they have plants, and they use them for their own personal use. But the scale of the economy to do these today is really not effective. You have to grow acres and acres and acres if you want to have a commercially viable product to then put on the market. You have to grow acres and acres and acres if you want to have a commercially viable product to then put on the market.
You know, some of the plants we still use, like autumn crocus, are still used for colchicine, so you know that goes on. But to have large medicinal gardens to extract medications really is not the same as it was years ago. Now, I do say that that keep in mind that 80% of the world still gets plant-derived medicines, and the World Health Organization's list of essential drugs contains a lot of medicines that are plant-based medicines because of where they are in the world, they don't have access to the modern medicines that are still plant-based medicines. So it's still used, but in some of the more, you know, modern societies, not to the same extent it was used years ago.
Andy:
I'm kind of curious, as somebody who does gardens, what your thoughts are on these types of plants and how climate change might impact the regions where they grow. Is there any? I'm just kind of curious if you have any concerns or risks that you think might come up in the future.
Dr. Greg Susla:
Sure, I think that you know a lot of it probably goes back to the use of both climate change and the use of pesticides and herbicides, insecticides, and the like, let's say, killing off the pollinators. So, killing off the bees is going to have an impact on the ability to grow these plants. So I think not only the weather that can destroy, I think, the climate or impact the climate where a lot of these plants are grown but also the chemicals that we use today can have a significant impact as we reduce pollinators and things like that. I think the other thing, the commercialization or the sprawl of mankind and closing down on areas where these plants have grown and taken away these plant areas or these garden areas and putting up a parking lot, I think it's going to have an impact too because you lessen the area where these plants may have been obtained.
Andy:
They don't evolve with their environment anymore; ultimately, they'll struggle to exist outside of controlled ecosystems in the long term.
Dr. Greg Susla:
I think that's a fair statement. I'm not a biologist or botanist, but I think that sounds like a fairly safe statement.
Andy:
So one of the posts you had in the columns was around foxglove, which is, I guess you could call it, a hyperbolic plant like it's something either people love or they hate because it's a beautiful flower, but it can be so dangerous. I noticed that was something you'd included in the garden at some point. I'm not sure if it's still there, but I'm curious about if that's something that draws people in when they see it or, you know, is that something that you, in retrospect, maybe regret planting or like? What was that plant's role in the garden and, I guess, in our understanding of plants as medicine or poison?
Dr. Greg Susla:
So I think the first thing is that and I want people to understand all plants are poisonous or have the potential to be poisonous. People think these plants are natural; they're safe. They're not. You know, we'll talk about some stories about that. Foxglove is a relatively dangerous plant if ingested, but other plants do bad things. Now, the other thing that I wanted is not so much used in America, but if you go to Europe, a common name for a medicinal garden is a poison garden. So you can't see this. But I have the Blarney Castle poison garden map.
If you go to Alnwick Castle in Northampton, England, they have their poison garden, and the sign on the gate says these plants can kill. So I want people to understand that just because it's a natural plant and they have it in their backyard, it doesn't mean it's safe. It means it can be extremely toxic. So you bring up foxglove, which can be a toxic plant and has agents that affect the heart, digoxin, digitoxin, and wabain like that, so it could be a cardiotoxin, if you will. So it could be a cardiotoxin if you will.
But if you go to Blarney Castle, in the Blarney Poison Garden, they have a plant called Belladonna, which I wrote about in the column, and Belladonna brings us three drugs. It brings us cobalamine, which we wear in patches behind our ears for motion sickness. It brings us atropine, which we use to dilate the eye in your doctor's office and speed up your heart rate. And also, it has high admin to settle your stomach. If you go to the Blarney Castle and look at Belladonna, it's under a cast iron grate. It's a beautiful plant, an absolutely stunning plant, and it has beautiful berries on it, purplish to blueberries, which are extremely toxic and it's toxic to children, but they look delicious. They look delicious, exactly; you're exactly right. And so little kids may eat them and have an adverse event.
I had belladonna in the garden a couple of years ago, and when it died, I didn't put it back because of the safety risk of having it there. I'm not worried about foxglove. If you go to Ireland, you're going to see foxglove growing all along the sides of the road. It's ubiquitous on the sides of the road.
I don't think it's that toxic, but, like Belladonna, I felt it was too poisonous. It was too hazardous to put that back in the garden. So when it died, I didn't plant it back. So I think you have to look at this in the range of, let's say, safety, in the sense that there are two ways to look at safety: A: it doesn't work, it's ineffective, and your disease is going to progress. Or B, you can go to the other extent, where it's just too toxic, it's not safe if you ingest it, and everything else, I think, is probably somewhere in that spectrum. From that perspective, it is important for people to realize all plants have the potential to be toxic, even because of the active ing’ the active ingredient or some other chemical constituent or contaminant that may be in that plant.
Andy:
So that, I think, points to one of the challenges as somebody who doesn't have that extensive medicinal background. So like, if you go to, like, I went when I was in college, I went to like this Salvation Army and got like this old book from the 70s that was like the, you know, the encyclopedia of medicinal plants, and it's like three inches thick and you know, a dumb 19-year-old was like oh, this is so cool, Like I'm going to, you know, utilize this. And then you go through it, and it's overwhelming, and everything from dandelions up is considered somehow medicinal.
And I'm just curious: from your perspective, what is a realistic understanding of how plants could be incorporated into a healthy lifestyle, a backup plan, or whatever you might want to call it?
Dr. Greg Susla:
So first, you know, the science of studying plant-based medicines is called pharmacognosy, and that goes back to the 1600s. And so we, we there's truly a science behind plants and plant-based medicines, and it's it's a true science. It was taught in pharmacy schools up to about probably the early 1970s, so by the time I went to pharmacy school, it was gone. I think people have to realize that. I think there are a couple of things here about looking at this. First is that you can have the confluence of the perfect storm if you don't know what you're doing.
So, in the sense that A, what you think you have may not be what you really have, and what is the accurate diagnosis? And so you need to be, you know, understand that that rash on your hand may not be contact dermatitis. It may, in fact, be an autoimmune disease that's manifesting as a rash. The second thing is, based on what you think you have, what are the natural treatments for it, and what's the science behind that? And I think one of the things that should, I think, elicit a question in someone's mind is when they go to that textbook, and I see it can treat everything from hemorrhoids to brain cancer. Something's not right here.
It can't be that effective for all these ranges of diseases because drugs just don't work that way. And that's got to raise a question in someone's mind. Gee, I'm going to use this for contact dermatitis, but it says that I can treat heart disease, and oh yeah, my grandfather's got prostate cancer. That's good for that. Maybe I should give him some of this too.
That doesn't make sense, and people need to understand that when they select these things. And then how do they know? How are they making the decision that it works? You know, echinacea probably has no medicinal value. It's a billion-dollar drug, and people take it and say, oh yeah, I took some echinacea, and seven to 10 days later, I was better. Well, that's probably just the course of your viral illness.
And so I think there needs to be an understanding of A. You can find that textbook, and it says my God, these plants are wonderful. Look at all the diseases they cure. As I said, asking the question doesn't make sense, and if you see that it has something that you think you have, then go out and really try to do your due diligence to see what is the actual science of that plant, the chemical it contains that actually treats the illness you think you have. That needs to be done. We're getting a lot more of that now going forward. The NIH has an office on alternative medicine, so we're looking at studies. I participated in some of those studies, so we need more of that to focus on and hone in on what these plants are, what chemicals they contain, and what they are really effective in treating before we start taking them.
Elliott:
That brings me to one of my questions. For herbal medicine, it seems you need various plants in various phases in order to create safe vehicles to accurately dose. I guess my question is, how do you see the future of growing these plants versus growing them commercially and extracting the active ingredients to make regular RX drugs? I guess you're saying the only safe way to do that going forward is to take the RX drugs, where the active ingredient has been extracted and put into a vehicle that you can safely dose, rather than having all of these alternative side effects or the question of this cures trench foot as well as it makes my fingernails grow faster, exactly so.
Dr. Greg Susla:
India is the medicinal garden of the world today. A lot of work is being done in India, where they have a significant number of indigenous plants that may have some additional value. I think it's like 45 to 50% of plants have that. So, there's a large endeavor looking at some of these plants all around the world. So it's not just India. India has the largest population; they're looking at many of these plants.
The second thing you have to realize is that when you have the plant in its natural state, think of it as a terroir for the wine you can't guarantee the climate, you can't guarantee sun exposure, you can't guarantee water, and you can take a plant, take a plant and take one leaf off the plant and take another leaf off the plant and they can have two extremely different concentrations of that chemical.
And it's not just the chemical; it could be contaminants or whatever. You may need the plant leaf to obtain the chemical, but oh yeah, the root or the stem or the berry has a toxin in it that may contaminate it, so that's what you have to do. The other thing is that a lot of plants have, I'll use digoxin as an example, a lot of other chemicals that have cardiovascular or cardiotonic effects. So if you look at digoxin or digitalis purpura, the plant that we use to get digoxin, which is a linoxin trade name, it also has a rapidly acting cardiac glycoside cell called wane, and it has another chemical called digitoxin, which all three chemicals we've used throughout the years to treat heart disease.
Elliott:
So this is from the Foxglove, correct?
Dr. Greg Susla:
Yes. It has three active agents that you can separate and use individually or reuse in years past. Now, why is that important? Up until the 1970s, there was a product called PIL Digis, and all it was was ground-up digitalis leaf. So it was digitalis leaf, purpura, which contained digoxin, digitoxin, Swabian, and other chemicals. And so, what was difficult about that product, which contained all of the constituents found in the digitalis purpurea leaf? It was very difficult to titrate someone's heart condition. That's the same thing you would do in your backyard, if you think you could grind up some leaves of whatever and use them as tea, soup, or whatever.
There's no way you can guarantee the purity of it, the consistency of what you need or the dosing of it. There's just no way you could regulate it on a stable basis. Hence you go, you find the chemical in the flower, you grow the plant or whatever, and then you bring it back, harvest it, purify it to get only that chemical out, and then the purity and the potency are guaranteed. So if you need a certain dose, in pharmacology we do dose ranging studies to see what's the dose you need to impact whatever condition you're treating. So now you know that you've got this chemical from this plant, you know it's pure, and it's potent in a dosage range that will actually treat the illness. That's what you do. You cannot do that with a plant. You can't grind up a plant and get that type of purity and potency to actually control a disease with any kind of regular consistency.
Elliott:
Right. So it's all about proper dosage. So these chemicals are found in the plant naturally, but without dialing in, and, you know, getting down to a purity level where you know this exact amount will fix, you know, my slow growing fingernails, or whatever it is, then it's not medicine. It can be that's where the potential harm comes into play.
Dr. Greg Susla:
So I'll tell you these are a couple of true stories. We talk about harm. We get the Georgetown University Medical Center newsletter every quarter, and last year they had a story of a young woman who wanted to have a very healthy, holistic life. She was into yoga, watching her diet, being very in tune with her body and her lifestyle, and so she was taking natural products. What happened is the natural products she was taking harmed her liver to such an extent that she needed a liver transplant. That's the downside.
And so I was in a study when I was at the NIH in the 1990s. We had a lot of young men coming up from Washington DC who are HIV positive, taking St John's wort. Obviously, it's used as an antidepressant, but it was also believed at the time to may have some antiretroviral activity against the HIV virus, and so one of the HIV service physicians asked my colleague I wonder if there's anything bad about St John's wort? Does it impact any of the medicines that these people who are HIV positive and trying to control their disease, does it impact any of the medicines?
So my colleague rounded up 16 normal volunteers. I was one of the 16 normal volunteers and we took the medicine for a week or so, and they measured our blood levels over time. And then we took St John's wort for a week, and we took the drug again for another week, and one day my colleague calls me and says You have to come to the lab. You're not going to believe this. And so I went down to his lab and he showed me that not only did the St John's wort rev up all of our livers to the extent that it was metabolizing the HIV medication was called Indenivir to such low levels that it may not have worked, but the impact out of all 16 of us was greatest on my liver and there was almost no drug in me after taking St John's wort for a week.
So did it actually cause toxicity in my body? The answer was no, but it impacted this drug we were taking, and it could impact the men who are HIV positive. That the conclusion of the study was that if you took this drug Indenivir and St John's wort, that it could reduce the levels of Indenivir to the effect that it wouldn't be treating your HIV disease, where the HIV could become resistant. So that's the downside is that you're taking something. Oh, I feel great. I'm no longer depressed. Oh, by the way, it's impacting another drug I'm taking to control my illness and now it's not working anymore. So that's a negative adverse effect from that perspective.
Elliott:
Right and I think that calls back to a point you made earlier was when you said with these herbal medicines how effective are some of these remedies when it could make you feel better but also give you other side effects or mask other symptoms, based on how you feel after you take the prescribed remedy?
Dr. Greg Susla:
Right, I think you know masking symptoms or not understanding the symptoms. Like I said before, what you think you have, but it may be in fact something else. And you know the story I alluded to, where I gave a talk a couple of years ago and a woman came up to me and talked about her daughter who had a friend who had a child that had these seizures, new onset seizures and she talked to a friend of hers who was into herbal remedies and said you know, your child just has these infantile seizures. He's going to grow out of them here.
Take this medicine, whatever it was, lo and behold, the seizures got worse and lo and behold, he didn't have a seizure disorder, he had a brain tumor. So, in the sense that people who think that they, one of the classic sayings I get is I know my body, I know it works. Well, in this case, the child was harmed. It was a delay in seeking appropriate therapy that she thought and believed, based on her friend saying you always got infantile seizures, and in fact, he had a brain tumor. And I think that's the risk of using compounds like this. Or, you know, I'm not saying these are very valuable sources of very effective medicines, but if you use them appropriately, you may delay therapy or you may mistreat something, in the sense you need to treat something other than what you think you're treating, and I think that's important to recognize as a risk.
Andy:
Yeah. So that kind of leads to my next question, of kind of what the role of these plants is, not just in modern medicine, but I guess, in the future. Part of this, I think, is that people have so much distrust right now, and I mean you can just look at the vaccine rollout and how many people refuse to take this vaccine, that people just don't trust the government, they don't trust corporations, they don't trust the media. Is there anything like what is the role of these plants as people, I guess, turn to themselves and try to find some sense of control of what's going on around them?
Dr. Greg Susla:
It's interesting. First off, these plants will always be viable sources of very effective medicines, there's no question about that. Like we talked about earlier, people who want to avoid natural people who want to avoid, let's say, you know, chemical medicines. Well, you're taking a chemical when you take these natural products, and one of the obnoxious slides I have in my talk is it's not about the plant, it's about the chemical in the plant, and people need to understand that that. I actually had a discussion a couple of years ago with a woman who really believed that it was the leaf she was taking curing her disease and not the chemical in the leaf.
And I think people either want to believe that or don't really understand it doesn't work that way. And so I think people who want to do this there, I think they are first off, like I said before, that you want to avoid modern medicines, you want to avoid modern doctors, you want to avoid, you know, the pharmaceutical industry, but what you're doing, like we talked about before, is maybe putting yourself at risk because you think you're taking something natural when in fact, what you're growing in your garden may be contaminated, may not have enough chemical in it to treat what you have, and so I think that with people doing that, all you're doing, I think, is deceiving yourself and maybe preventing yourself from actually getting appropriate care.
Now I'll tell another story that my wife and I were in Edinburgh, Scotland, a couple of years ago, and we went by this herbalist shop dating back to the 1860s, and lo and behold, I'm reconstituting an 1865 medicinal garden in America. So I went in to talk to him, told him I was a pharmacist and he was a trained herbalist. So the Edinburgh Botanical Garden has a nine-month thesis-based diploma-granting program to become an herbalist and he was a graduate of that program. And so I was talking to him and he had a beautiful shop. Again, it's 120 years, 160 years old.
And so we got to talking and I said, how do you know that what's on the label on that bottle is what it is in that dose? And he said we don't. He said it's not regulated like regular medicines. We have no idea that in fact it is. We think it is, we have no doubt, but can I guarantee it? The answer is no.
I said, what if somebody comes in here and says You know, I don't want to use a real medicine, I have this disease or that disease or whatever, I don't want to take. You know these commercial medicines made by the pharmaceutical company. I want something natural. And he said flat out go see a doctor and get a real medicine. And so I think that that here's somebody who's trained in this field, who has a realistic view and says if you're really sick, you need a real medicine.
And you know, if you don't, if you don't treat your hypertension appropriately, you're going to stroke, you're going to kill your kidneys. If you don't treat your diabetes appropriately, there's going to be consequences with blindness and neuropathies and things like that. So the reality is, can you do this? Sure, you probably could, but I think the effort it's going to take to do this and actually to control your disease, I don't think most lay people have the knowledge and understanding to do that.
Elliott:
It seems like there's a difference between like. It seems like no, there definitely is a difference between basic first aid and treating small ailments versus actually curing diseases and tackling larger health problems. With these plants, it seems like they run the gamut of doing a lot of things. So, are there any plants you would recommend in a small garden, or for people who like to grow their own tomatoes and peppers? Is there anything you can think of that has common use, is safe to put into home gardens, or would you recommend or use personally?
Dr. Greg Susla:
I would use nothing personally. So unfortunately, you know, I'm a pharmacist and I come from big science and I think that there's no guarantee that what you put in there is going to be, I think, adequate to treat something. I mean, sure, we all have aloe plants in our house, that when you get them right off the iron skillet, you put aloe on it. I think that's fine. I think that other things, I think it's just too risky. And I'll be perfectly honest, yeah, I'm a pharmacist, I'm a big science guy.
I think these are great ornamental plants, but I think the risk of you trying to self-diagnose yourself with a condition and then go to your garden and take something out of your garden and use that as an active therapy, I think the risk is too great. People do it every day. I'm not. I understand that and people will say I can tell you wrong. I can tell you I do this every day. That's fine, but I think the average person doesn't have the scientific, the medical background to really understand what they have is what they have and that what they're going to pull out of the garden actually works for what they think they have. I think the risk is too great and I think that there's. They've actually done studies to look at what compound is actually in that flower and oh, by the way, it only had minimal amounts. Why is that? The weather, the location, the climate, the soil, whatever? That's the risk.
Andy:
Do you think there's value in getting people exposed to these types of medicinal gardens in order for them to, I guess, be more aware of? I think there's like a little bit of an aura that surrounds this world of like natural medicine and these types of things. I think with science, we have this really unique opportunity to smash that mirror kind of whatever you want to call it that kind of makes it seem like it's outside of the scope of logic.
Dr. Greg Susla:
I guess you could say I think that's a great idea. I think people need to be exposed to this, to understand the beneficial impacts of the chemicals we get from these medicinal plants and the risks and limitations. When I talk on this subject, I give my public service announcements about. These are the risks that you're going to undertake if you think you can do this, and you know, one of the questions I get is why can't I do this at home?
I said, well, do you fix your car at home? Oh, no, I take it to a mechanic. Well, what makes you think you could diagnose yourself and then treat it with these plants from your garden? And it gives them pause for a minute because, oh, I never thought of that. And so I think people need to understand.
Like I just said, no one's questioning the value of plant-derived medicines and we're going to be doing this for the next thousands of years. But you need to understand the risks. You can't do this at home without the knowledge of what you're actually looking for, the part of the plant you need. How are you going to refine it? How are you going to purify it? How are you going to extract it? How are you going to guarantee the potency? If you can't do that, then what are you doing?
Elliott:
I think this calls back to what Andy had said earlier about the mistrust, and I think that's where the divide comes in between what Andy had said earlier about the mistrust and I think that's where the divide comes in between people seeking natural remedies versus taking commercial prescription drugs is you don't know, we don't know what's in the plant, we don't know the purity of the active ingredient that we're seeking versus we don't know if they're putting like. How do you know if they're using the natural active ingredient versus chemical analog that they've created in a lab that looks like it under a microscope but might not necessarily be the natural ingredient?
Dr. Greg Susla:
So that's a great question and I'm glad you asked that. Because if you have, I'll say this, we'll use foxglove and theoxin as an example to answer this question. If you go and take some foxglove leaves and actually extract digoxin from that leaf, so you have naturally obtained digoxin. If you then go into a laboratory and pull a bunch of chemicals off the shelf, go through several chemical reactions, and come up with digoxin that was chemically synthesized, guess what? It's the exact same compound. It doesn't matter that you got it from the plant or that you synthesized it in a lab.
The structure of digitoxin is digitoxin or digitoxin or scopolamine or whatever. It doesn't matter. At the end of the day, the chemical structures are the same, it's the same product. If you ran them on a gas chromatograph, one from the plant and one from the lab, guess what? It would both give you the same printout at the end of the day. So it doesn't matter where you obtained it or how you made it. The compound is still the same compound and because one came from a plant and one came from the lab, at the end of the day it's still digoxin or digitoxin or whatever.
Elliott:
It's the exact same thing and that's what turns it from a plant into a medicine. Is that exact process?
Dr. Greg Susla:
Exactly. I think what's interesting I look so when I write the column for the museum's website that I use the United States Pharmacopeia, which the United States Pharmacopeia has been around since 1820 it had its 200th anniversary last year and that sets the standards for purity and potency for all drugs approved in the United States. And if you go through the USP, it tells you exactly how to extract at least in the 1840s, 50s, and 60s, how to extract that chemical from that plant to then use it as a medicine. And we still do that today. So the USP sets the standard for all the drugs we use today.
Andy:
So I guess this kind of brings me to something you brought up that I wasn't even aware of or never really occurred to me: the involvement now with government agencies and alternative medicine. I think there's a lot of fear from people that don't know a lot about this industry that it was legitimizing an industry that shouldn't be legitimized.
But it sounds like it's actually something a little different, where they're trying to get a hold of what these companies are doing and selling over the counter, or not over the counter, on shelves. There's no regulation, and what's actually in any of these things that are natural, whatever extracts, medicines, we don’t know but we should.
Dr. Greg Susla:
Yeah, and I think they should. So if you go back to the FDA, the FDA came into being. I forget the exact years, but the Food, Drug, and Cosmetic Act talked about the purity of compounds. If you go back 100 years to the 1920s, today we use strychnine as rat poison. Strychnine was used as a tonic in the 1920s, had no therapeutic benefit, and so I think that a lot of people sold snake oil as therapeutic remedies, and we all know.
So we never really got into the safety and efficacy of drugs. But probably one of the biggest, saddest events of the 1950s was a drug called thalidomide, where mothers took thalidomide when they were pregnant and they birthed babies that had deformities. And that's when the FDA really took a role in studying the efficacy and safety of drugs. Also, along with that, they have guidelines for purity and potency, along with the United States Pharmacopeia.
When we did our St John's wort study, we could only find one product that guaranteed it was St John's wort in the dose specified on the label. So that tells you a lot right there when you can go and buy. Like the gentleman in Edinburgh, Scotland, said, yeah, I can't guarantee what's in that bottle is what it is in that dose. When you can't guarantee something, then what are you spending your money on? If you think that that is whatever chemical it is to treat whatever ailment and there's no guarantee that it is that chemical, it is pure and it's in that dose, are you willing to take that risk and spend your money on that?
What government regulations want to do is regulate to say, yeah, that compound is that compound. It's going to be plus or minus 4% when it's in that bottle and you take it. Right now. We have no guarantees when you walk into a store and you buy alternative medicines. Given that it's not regulated, you have no guarantee it is what it is and that the label specified dose. That's the reality. And so if you won't do that, that's fine. I'm not willing to do that.
Elliott:
And so that brings me to my next question. I work in the medical marijuana field in Massachusetts. That's exactly what the regulation is trying to boil down to right now, is we have to guarantee what exactly species, dosage, and percentage of active ingredient is included in the plant. Do you have any experience or do you see this being used as medicine going forward now that it seems to be losing its tinge and coming into the realm of medicine as accepted practice?
Dr. Greg Susla:
I'll tell you two stories. If you go back to the 1840s United States dispensatory and you read about cannabis americanus, it talks about the giggles and the munchies that a lot of people know from their college days. But I think, on a serious note, cannabis Americanus goes back over 160 years. There's no question today about the medical benefit of marijuana, cannabis and the various constituents within marijuana. I think it's a very viable medicine used.
I remember when one of the constituents came out when I was in pharmacy school in the late 1970s. Used for cancer-related nausea and vomiting, cancer-related reduction in appetite, and things like that. So it used to stimulate the appetite, ie, munchies, that I think there's great value to the compounds contained within marijuana. I think it's been, you know, misaligned for a long, long time when it shouldn't have been, because I think it has great value and, I think, in the right hands and the right farmers, if you will, growing it and showing that the product is a quality product.
I think that's what we need. It's a great analogy for how we should look at other medicinal plants and their compounds, like the way we've looked at medical marijuana, because I think it's a great model going forward.
Andy:
You've had a long career in medicine and it sounds like you've had a pretty extensive history in gardening and being around plants. I'm curious if that relationship with the gardening aspect and the plants themselves has changed your perspective or how you think about medicine, both from the alternative side, which is obviously super problematic, and also the traditional side. Does it give you a little bit more of a nuanced understanding of each of these positions?
Dr. Greg Susla:
Well, I think what it does. The way I put it in perspective today is when I look at my 1850s medical and pharmacy textbooks and the way the doctors and the apothecaries, pharmacists understood how these medicines worked in the mid-1800s. It's where we are with lay people today, because I see the exact same analogies and people talking about a lot of experiential evidence of how these chemicals worked, hey, I took this, I had this, I took this, it worked. Of how these chemicals worked, hey, I took this, I had this, I took this, it worked. And to read the descriptions of doctors taking the medicines and not knowing the science.
Now that I know the science, I understand what they're describing, based on the modern day science that wasn't available to them back then. If you read again, using Foxglove as an example, if you read the 1850s medical textbooks and doctors describing dosing themselves with Foxglove or digitalis papura and getting sick two or three days later, getting really sick and really toxic. Well, it takes that long for digoxin to accumulate in your body and then it takes some days to recover. Well, it's because it's called a long half-life, it takes a long time to leave your body. They didn't know that in the 1840s. We know that in 2021.
So I understand now what they're saying, based on modern day science, and I think if I look what I read in the 1840s and I read a lot of the lay stuff on the internet or in these natural remedy books you can buy what they're describing is really a lack of understanding of how it works, and so by doing what I'm doing, I'm really have a greater appreciation for how much science is really added and how much science has accumulated over the last 150 years, since the time of the Civil War, where my garden is based to where we are today.
The amount of science and I have to give them credit. You know they did a lot of studying back in the 1860s, and they found a drug like Arnica was quite toxic, if you took it internally. Well, what did they do? They took it out of the official compendia and so, yeah, you can use it for scrapes and bruises and things like that externally, but you can't take it internally, and now it's no longer a recognized official compound.
Andy:
So I think they were very intuitive and as the science came along, they really changed their views on how drugs should be used, if they should be used at all. So do you have any, I don't want to say hope, because I feel like that has some implications, but you made a comment about that. You feel like the layman today is where science was 150 years ago, do you? I guess I'll stick with hope. Do you have any hope that the layman will improve in that knowledge?
Dr. Greg Susla:
Yeah, I think we're seeing that today. Like I said, the book I have on natural remedies from the 1970s is just horrific, and some of the new books I have today are really evaluating some of the science. This one book I have rates the quality and the quantity of science. My book on medicinal plants from the Chelsea Physic Garden in England talks about contraindications.
So I think that, with all the knowledge we can glean on the internet, the internet is a wonderful source for people to really investigate a compound that they want to take, whether it's something from you know, medicinalherbs.com, all the way to scientific studies. They have access to that today and I think the way people are becoming more knowledgeable and more informed, I think they have the opportunity to go out and to investigate these compounds. Whether they're willing to do it and take the time is another issue, but I think the information is there to help them decide. I think to go naively into a garden and pick a flower and ingest it today, I think there's no reason to do that. I think you have so much knowledge out there that if you're willing to take the time to access it, you can make an informed decision.
Elliott:
And that brings up a point because I'm a novice to gardening and, like I said in a previous episode, the only thing I've ever planted was in a red solo cup and I'm pretty sure it sprouted and then quickly died. But when I think of herbal medicine, and I can only think of pop culture and references to old shamans, and usually it's older people who have accumulated a wealth of knowledge in how to use these plants safely, it's never some young and up-and-coming rising healer or anything that knows everything about these plants. It's always somebody older trying to pass down the knowledge, and I think that's why these plants will probably remain in aesthetic gardens, moving forward, rather than being introduced to the wild. But there is one plant that you did talk about in the blog that I wanted to bring up, and that's the hops. So could you tell us more about the Maryland-style hops you had bandied about?
Dr. Greg Susla:
So that was there from the previous iteration of the garden, so we planted that. But clearly beer, mead, wine goes back thousands of years. The water was contaminated, so people drank mead, wine, beer, and stuff like that. So I think beer, as an example, hops, let's say, as a, you know, primary constituent of beer, probably clearly had more social benefit than I think medicinal benefit. So I think it was part and part of that.
When you think about, you know the weigh stations along the road and people stopping off and having their pint of beer because the water was bad in the you know, thousands of years ago, I think there's more social benefit to beer than there is medicinal benefit I can't think of, you know. I'm sure there is, I don't know. I've never really investigated that from a medicinal standpoint. You can find hops in the medical textbooks of the period. I really haven't investigated it that much farther.
But I want to return to your comment about the shaman a moment ago. So a lot of what we know about natural medicines goes back thousands of years, where maybe early man looked at what the animals ate and what they didn't eat, and so, oh, that's pretty good. Just look around your household gardens and what the deer and the groundhogs eat. Why do they eat one thing and not another? It's because they don't like the taste. Is there something prickly? They don't want to get pricked in the nose when they go and stick their nose in the garden. Or is it toxic? So a lot of people learned first from the animals and then they probably saw, they took some of these plants and they realized, oh yeah, it had a positive effect on something and that was collected and then that was passed down over the generations, you know, mother to daughter, and then you had maybe the village healer, the shaman, the medicine man or whatever.
If you look at Native Americans and the medicine man, and looking at some of the you know peyote and stuff like that, there, I think that's a huge source of untapped information. To go to these healers, whether they're, you know, medicine men in Native America or other medicine men around the world to talk to them, to find out what is it, why are you using it and what do you see, and to then to take those compounds and investigate them to see what the active compounds are and do they actually work for that disease that the medicine man is using it for, or does it have other medicinal values that could be where it could be used. So I think that's a huge untapped source of information. We're going around the world, picking plants, and investigating them for their medicinal activity. Yet there's a whole body of men or women who know this.
When I was at the NIH, one of our critical care medicine fellows was a Native American and her grandfather was a Native American medicine man and he was traveling around the country to medical schools. He came to Maryland and lectured at Johns Hopkins University School of Medicine in the early 90s. That's an untapped source of knowledge. To at least understand what they're using, why they're using it, and what the effects are, that I think that's another active area for study.
Elliott:
Absolutely so. It sounds like the knowledge is already there, and the science at this point would be coming to reaffirm and confirm what is already known or what's already been in practice, for you know longer than the books have been in play.
Andy:
Yeah, and we have the opportunity to further isolate the chemicals that we may not know about and use them more accurately, I guess in appropriate ways.
Dr. Greg Susla:
I think that you know. I think, once you realize what it's used for, it's like oh wait, it's not going to work for that. You're going to get better in seven to 10 days, so to speak. But you know what it's got this structure. It falls into this class. I think we can use it to treat something else.
Elliott:
I'm sure every doctor could use more tools for the toolbox.
Andy:
So you've mentioned that there's still a lot of research going on in these plants. I again, I don't come from a medical background, I'm a farmer and a tax guy, so this is like just a hobby of mine. I was always under the impression that medicine had not exhausted but had, for the most part, gone through the plants out there. It seems now I guess, that that's not really the case in terms of like what the research has been that's been done, like how how much of the plants that are out there that we've, that we know about, do we actually have any data on?
Elliott:
Are there any new discoveries? Are any plants that are being rediscovered?
Dr. Greg Susla:
I guess right well, that's like I said before. India is the hotbed for looking at plant-derived medicines, and if you actually go to the scientific literature, there's a lot of studies coming out of India looking at chemicals being derived from that. Now, some of these chemicals may be similar to chemicals that already exist, so you may have compound A that already exists. But oh, by the way, we found compound B in this plant, which has similar activity. Can we use that in people who no longer respond to chemical A? Do people have a greater response? Is it more potent, so to speak, than chemical A? So, or is it something new, a completely different class that acts the same way or acts differently, that either helps chemical A work or works, you know, or has the same input or efficacy as chemical A? So that's a very active study right now.
So, are we going to go back and look at Foxglove and Digitalis purpura for, you know, new digoxin products? No, but we're going to go to other parts of the world and look at these plants to see what their chemical structures are, and there are only five basic chemical structures.
And if you look at that, once you see what the chemical structure is. You can then go out and kind of assimilate that to well, where does that fit in these classes of medicines to be used? So, is it a steroid? Is it one of the other compounds or structures that can be then modular, modified to have an antibiotic effect, have a chemotherapy effect, have a cardiac effect, or have a pulmonary effect? What can they do with that? So that's what they're doing right now. So we've exhausted what we know but don't know what we don't know. That's still out there, and I think that's the exciting part.
Andy:
Yeah, that's. It is exciting, I guess, really hopeful in terms of the things we haven't solved yet medicinally. So I guess you've kind of alluded to it at this point for people interested and wanting to know more and going in with their eyes open. It sounds like there are a couple of books you would recommend, even if it wasn't necessarily because you're going to use it, but you think are fair and accurate representations.
Dr. Greg Susla:
I think one of the more respected sources, and it's fairly straightforward, is Peterson's Field Guide to Medicinal Plants and Herbs in North America.
I have that on my coffee table, yeah, there you go, so you know what it looks like, and I think it's a nice overview. But again, you know it's not really giving you a lot of the science. I think you're familiar with that, but I think it's a good starting point. This is a place where I'm working on the garden. If my wife and I are going to someplace, this is the book I throw in the car. I think it's a good. It's a well-respected book. I think it's well done.
There are others out there as complete as this, and the one that I got yesterday, you can get this on Amazon, is from the Chelsea Physic Garden, herbal. It's Healing with Plants 2021. It's actually beautifully done. It's really nice. It's got some basic drugs in here and it's I think it's realistic. It talks about contraindications and cautions, so the first section is caution, which I think is helpful. So I think these would be two books. I would start with Peterson because it's just been around long ago. It's well respected and the Chelsea Physic Garden's been around since 1673. I've actually toured it a number of years ago. I think the quality of their work. I'm actually a member of the garden. I think they do nice work. So I would start with this.
When I've looked on the internet, there's such a hodgepodge of information out there. I think the internet is missing something. Anyone can put anything on the internet, and I think that's good and bad, and it may be hard to decipher what's out there. I actually looked at one site, which I don't remember what it is now, but when it talked about medical uses, it had every conceivable illness under the sun, and that's an exaggeration.
But nothing works against everything, and you have to understand the limitations of these medicines before you say that they're going to work for this, that, and the other thing. It doesn't make sense, and as a pharmacist, I know the science to understand that. I think they may not be able to do that as a lay person. They may take it at face value and then get something that they didn't expect from taking that plant.
Elliott:
And that's been abused in time. Memoriam going back to the Old West, when you mentioned snake oil earlier, exactly, and people taking advantage of that, making a quick buck.
Andy:
Yeah.
Elliott:
I guess that's the warning, that's the caveat. You can either trust somebody to sell you a medicine that they say works, or you can go out and eat your herb garden.
Andy:
Yeah, I mean, I find it frightening personally if you go on YouTube and see the number of people my age or younger who are so-called experts in things like medicinal plants. I just don't see how that's possible, and that can be a dangerous game.
Dr. Greg Susla:
You know, I graduated pharmacy school 40 years ago.
I have eight years of training and 40 years of experience and I still don't know.
And I think for people to become, you know, the coroner herbalist, I think it’s fraught with risk and I think that you know a man's got to know his limitations.
And just because you read a couple of articles in a book or a couple of articles on the internet, to start prescribing natural-based remedies for diseases that you may not be familiar with, especially telling people what they should do, I think that's risky and I think that to me, as a healthcare professional, to see diagnosis delayed and harm coming to somebody because they didn't seek out medical, appropriate medical care at a reasonable amount of time, they tried to use alternative medicines and then they have something that can't be cured or the disease has progressed to the point where now they have, you know, it's impacted their body, I think that's sad and I think it's tragic I think that's a better word and when you kind of prevented something by going to see a doctor and getting a commercial, well-studied medicine, when you wanted to use something that was more quote healthy and you actually caused more harm, I think it is tragic. In the right hands, you have to understand what you're doing. In the wrong hands, it's going to be fraught with danger.
Elliott:
I'll wrap this up with kids. Don't try this at home.
Dr. Greg Susla:
Yeah, that's what I do Every time I get that question, and I lecture. That's what I tell people, Don't try this at home.
Andy:
So let me ask two, I guess two remaining questions. The first is, if people are interested in what you're doing, where would you want to send them? They want to learn more about the Pry Garden, or.
Dr. Greg Susla:
If they want to go and learn about the Pry Garden, they can go to civilwarmed.org, the main website for the National Museum of Civil War Medicine. Under the search area, excuse me, type in Pry Garden or Medicinal Garden, and they'll come to the garden's website.
Andy:
And are you guys going to be doing more updates on that website?
Dr. Greg Susla:
Absolutely, so we uploaded one last month on mints; peppermint and spearmint. I did see that.
I read that today, and I'm working on one on Senna, a Senna laxative. I'll submit that one this week, and then after that will be Valerian, which is used as a sedative, and then a Gentian after that, and then chamomile. So those are probably gonna be up over the next five or six months. So we're trying to do one a month. But the mints went up today, and hopefully the Senna one will be up by the end of the month. That's an interesting drug too, and I can tell you another story about that.
I have a friend who's a nuclear engineer, and he had some issues with some surgery, and he went to see a surgeon, and he talked to a friend of his, and said Oh, you don't need a surgeon, you just go take this peppermint tea. And so he called me a while after that and said, Greg, I've been taking this peppermint tea and I can't stop going to the bathroom, I can't leave the house. He said send me the diuretic. No, it was a cathartic laxative. And so when he sent me the label of this peppermint tea, peppermint tea, all over the box on the backside, oh yeah, it has 1,080 milligrams of senna leaves. Okay, we grow senna in the garden and 1,080 milligrams of senna leaves. It's actually a fairly large dose. If you actually go and pick up a bottle of Senecot tablets. The active ingredient in Senecot is senesides, and the actual dose is 84 micrograms, and the product was 1080 milligrams of acetyl leaves.
Elliott:
I can't even do that math. Yeah, there's commas involved.
Dr. Greg Susla:
Exactly right, and that gives you an example of you know taking this product. That's quite natural not understanding that it's not. He kept talking to it as peppermint tea. Peppermint tea, it's not peppermint tea, it's a laxative. It's got senna in it and 1,080 milligrams delivers. I don't know how many micrograms of senna side effects, but in him he had an overreaction to it, and so I think that's the issue about not doing this at home.
Elliott:
Good Lord bad night.
Andy:
Any other parting thoughts? Anything we didn't cover you wanted to cover?
Dr. Greg Susla:
No, I think that I think the only point I really want to convey to people is this is not something that you think you can do at home by yourself. You have to have a tremendous respect for this. Just because it's natural, it doesn't mean it's safe, and my very first lecture in pharmacy school was by the professor who talked about how to make tablets and capsules and the like, and he said I sat in your chair 20 years ago here at UConn School of Pharmacy. He goes I'm going to tell you this today because I don't want you to forget this For the next three years. You're going to hear about all the wonderful things that drugs do.
They're going to cure cancer, treat hypertension, treat cholesterol, but they also do bad things. They turn off pathways the body doesn't want turned off. They turn on pathways the body doesn't want turned on and they can cause bad effects on people, and I think that's important to realize. Although it's a natural product, it still can have bad effects if not used in an appropriate way, and so I think that to me, I just want my last two words are just because it's natural doesn't mean it's safe and effective, and I think that's important in respect to these plants, I think is paramount.
Elliott:
I'll add to that, or just tack on at the end, that this isn't a hobby and to give you credit where credit is due you've made this your career and your life's work and that's the kind of time that goes into it in order to give it the proper respect, from turning it or seeing it as a plant and using it as the medicine that professionals prescribe. I agree, I think that's a good point.
Andy:
Thank you so much for coming on. We appreciate it.