Body of Wonder Podcast

Episode #21 Ethnobotany: The Science of Indigenous Medicine with Michael Balick, PhD

Plants have provided human beings with nourishment, medicine, fibers, and other resources for millennia. And, the passing of botanical knowledge through generations not only ensured survival, it shaped how cultures understood their world. Occasionally, this knowledge would be exchanged with neighboring people in the forms of stories, rituals, and daily practices.

In the 1800’s Western anthropologists studying indigenous cultures began to categorize this relationship between plants and people as a new science called, ethnobotany, “ethno” meaning people and “botany” meaning plants.

Over the last 200 years the field has evolved to include ethnomedicine and most recently it’s application in modern pharmaceuticals.

But, how is it that centuries ago societies without modern laboratory equipment learned how to use botanicals with such precise applications and outcomes?

To understand this, we welcome Dr. Michael Balick, ethnobotanist, and Vice President and Director of the Institute of Economic Botany at the New York Botanical Gardens. For more than four decades, Dr. Balick has studied the relationship between plants and people. Most of his research is in remote regions of the tropics, like Micronesia, on the islands of Pohnpei, Kosrae, Palau and Melanesia, in the Republic of Vanuatu where he works with indigenous cultures to document plant diversity, knowledge of its traditional use and evaluation of the potential of botanical resources, particularly medicinal plants, for broader application and use.

Dr. Weil, Dr. Maizes, and Dr. Balick discuss why it's so important to understand ethnobotany in modern society, the benefits of “whole-plant” traditional medicines, and how ethnobotanists are working with indigenous elders to preserve cultural practices and ancient knowledge.

Please note, the show will not advise, diagnose, or treat medical conditions. Always seek the advice of your physician or healthcare provider for questions regarding your health.

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Guest Bio

Michael Balick

For more than four decades, Dr. Michael Balick has studied the relationship between plants and people, the field known as ethnobotany, and floristics, the study of botanical diversity within a specific region. His research has included studies in the Amazon Valley, Central and South America, The Middle East and Southeast Asia. His most recent scientific work focuses on Micronesia, on the islands of Pohnpei, Kosrae, Palau and surrounding remote atolls, and Melanesia, in the Republic of Vanuatu, documenting the diversity, local use and management of plant resources in these poorly known but biologically important areas of the world in support of biocultural conservation. Dr. Balick has authored over 150 scientific papers in peer-reviewed journals, and authored, co-authored or edited 25 scientific and general interest books and monographs. Recent books include Rodale?s 21stCentury Herbal: A Practical Guide for Healthy Living Using Nature?s Most Powerful Plants  and  Palau Primary Health Care Manual: Health Care in Palau, Combining Conventional Treatments and Traditional Uses of Plants for Health and Healing (with various coauthors). His forthcoming book, Handbook of Poisonous and Injurious Plants, 3rdEdition  (with Lewis S. Nelson, MD), is the standard reference for Emergency Department physicians addressing cases of suspected plant poisonings.  He received his Ph.D. from Harvard University and became friends with Dr. Andrew Weil during his time in Cambridge. He has been at the New York Botanical Garden since 1980.   

 

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Victoria Maizes: Hi, Andy.

Andy Weil: Hi Victoria.

Victoria Maizes: Well today on Body of Wonder, we have the distinguished Dr. Michael Balick joining us. He's really a leading scientist in the field of ethnobotany.

Andy Weil: He's also a longtime friend and colleague of mine. We were both students at the Harvard botanical museum. Long ago he was a graduate student. I was an undergraduate. And then I was in medical school when he was a graduate student, and we were both studying under Professor Richard Evans Schulte. Well talk about him some in the podcast. So we have a lot of connections.

Victoria Maizes: And about 80 years of combined experience in ethnobotany. Yes, well let's get Michael on

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Victoria Maizes: For more than four decades, Dr. Michael Balick has studied the relationships between plants and people in the field known as ethnobotany. He is vice president and director of the Institute of Economic Botany at the New York Botanical Gardens. Most of Michael's research takes place in remote regions of the tropics, where he works with indigenous cultures to document plant diversity and the traditional utilization of medicinal plants.

He has served on advisory panels for the National Institutes of Health, and it's on the Board of Trustees of the American Botanical Council. Dr. Balick has authored more than 150 scientific papers and written multiple books. Most recently he authored Plants, People and Culture: The Science of Ethnobotany with Paul Cox.

Welcome Mike.

Michael Balick: Oh, it's great to be here, Victoria and Andy. Wonderful to see you.

Victoria Maizes: Same. Well, Michael, I want to begin by having you define ethnobotany and speak a bit about your work.

Michael Balick: Well, ethnobotany is the relationship between plants, people, and culture. And back in the late 1800’s a young professor of anthropology got up before a meeting of the American Anthropological Association and said, “I'd like to define ethnobotany”, create a new word, define it as the study of primitive peoples and their uses of plants.

And as we now know those people, which Harshberger referred to as primitive are actually much more sophisticated in their knowledge of the environment and their knowledge of many, many things than we are. And we are seeking to learn from them. Ethnobotanists go to remote parts of the world.

I've had the privilege of working in the Amazon and central America on currently work in the Western Pacific in Micronesia and Melanesia. Melanesia being where I work is Fiji and Vanuatu. Micronesia and Palau. But we also work in urban areas.  New York city is an extraordinary center of diversity.

It turns out in New York city our residents speak up to 800 different languages and that means 800 different cultures and most of these are immigrant groups that have brought a lot of their practices with them when they came to New York city. And so for 30 years perhaps we've been looking immigrant uses of plants in New York city, not only what they bring with them, but how they adapt, how they learn from other cultures how, for example, a Dominican healers in Washington Heights interact with Chinese pharmacists in Chinatown and what they learn from each other. We've been working with Jamaican communities. My colleague Ina Vandebroek, is really the lead in this urban ethnobotany program. Urban ethnobotany mean being a word we, we actually coined to focus on urban environments and immigrant and diaspora cultures.

Andy Weil: Michael, you and I have known each other for a very long time, and we both had the privilege and good fortune to study under Richard Evans Schultes the director of the Harvard botanical museum.

Who's considered the father of modern ethnobotany. You were his graduate student. He was my mentor as an undergraduate, and then we were both on the research staff of the Harvard botanical museum.

Michael Balick: Yes, those, those actually were magical times because as you remember, there were 15 or 20 students and associates who are working all over the world, right. And they would come back to the lunch table and we'd hear stories, you know, the stuff that dreams were made of.

Victoria Maizes: I want to hear a story from each of you because I know how influential Richard Evan Schultes was to each of you. And that there are some fascinating stories to be told.

Andy Weil: Well, let's see when I was an undergraduate. So this was in the early 1960s. The counterculture was just beginning to develop in Cambridge and marijuana was just making its appearance and Schultes gave a section of his lectures in his Introduction to Economic Botany Course on drug plants on psychoactive plants.

And he mentioned cannabis briefly, but he really knew nothing about it. And I was looking in to the literature. There's very little written about it. There’s been almost no research on it. And I said to him, you know, you want to take an interest in this because this is becoming very prominent and there's not much about it.

And he shook his head but it did kindle and interest in him. And then he became, you know, a great researcher of the botanical arts of cannabis and began going around as an expert witness in cannabis cases. And it was quite wonderful to see that develop in him.

Michael Balick: What I remember the most is his Biology 104 Plants and Human Affairs, and how he would reach into his freezer and pull out specimens and samples from around the world.

If you've never held a 10-pound sugar beet in your hand it came out of the freezer and you could, you could really learn by touching and feeling and seeing. At poisoned plants lecture he would take his blow gun loaded with a Curare dart, thankfully not, not covered with Curare and shoot it across the room into a target. And the students were just shocked.

Andy Weil: I used to say that was the only course in my academic career, in which I learned anything practical. There was one lab on making soap. There was one on making ink. The first lab that I remember he had a Mexican graduate student and that student's wife came in and made a typical Mexican meal that was tortillas and guacamole. I mean, things, this was amazing. So we were introduced to all that, you know, through, through that course, through Dick Schultes

Michael Balick: And, and you could really voyage around the world, you know, while staying in that room, which is what ethnobotany, you know, gives people, I call it a gateway topic to bringing people into science. It's just, it's extraordinarily engaging, you know?

Victoria Maizes: Well, tell us how ethnobotany has evolved since Schultes era.

Michael Balick: Well, I think Schultes really pioneered bringing together groups of people from other disciplines other than botany and working on a problem, for example, as Andy mentioned, psychoactive plants, and I think we've brought it along a little bit further. We we've enlarged that collaborative of investigators.

For example, we have a project in Vanuatu where we're working with not only botanists, mycologists, conservationists, foresters, and linguists. One of the things I'm fascinated by and have learned a lot from, as my colleague, David Harrison, from Swarthmore, who's a linguist, a very accomplished and prominent linguist who developed with his colleague, Greg Anderson, the, the talking dictionary to try and preserve endangered languages. So in addition to doing botany where we're running around showing the plants to elders, recording how they pronounce it, taking photographic images of the plants, and David puts it all on his talking dictionary and really to, to provide cultural support to a community, to keep it together.

There's nothing people are more fascinated by then they pull open a computer or you can open it up on your smartphone and, and start showing pictures of plants, how they're pronounced in your ancient language, that people know who the speakers are… many of them are gone. This is their legacy. And, and the users of the plants.

So it's just much more integrated and I think there's a lot more respect also over the years for the value of the importance of the indigenous investigator, such that starting in the eighties, I would be including indigenous people as coauthors on my paper. Schultes certainly honored indigenous peoples in a way that most others had not at the time.

One leap that we've made is, is giving them academic credit for their contributions.

Victoria Maizes: You know, Michael earlier on you use the word primitive and I think we have a certain hubris in the West about how evolved and intelligent we are. We have obviously made enormous scientific advances and created incredible microscopes and other tools to measure plants.

And yet, centuries ago, indigenous people without access to any of this equipment learned which plants were good as medicine, which ones were safe to eat. In some cases how to detoxify things that weren't safe and they were using their senses in this incredibly rich way that perhaps, you know, we've lost the ability to use.

Can you speak a little to that term that you've referred to indigenous science and what we can learn?

Michael Balick: Sure. What I've found is that indigenous peoples use the Western so-called Western scientific method of trial and error, but I add to it success. So trial, error, and success. You might taste that red berry because the red berry that you ate and your village across the mountain gave you a lot of energy and you taste this one that looks similar, maybe it gives you a stomach ache. So you spit it out. You don't eat it anymore. That's your trial and error or it's gives you powers that, you know, energy that you never thought you would have. So that's the success. As far as toxins go, one example would be an endemic cinnamon tree, cinnamomum carolinense, on the island of Pohnpei.

Now that has a compound in it called safrole, which is a tumor promoter. And I, I, I wondered why people drank that as a healing tea and a tonic, and with all that safrole in it. And so what we did working with a group from Lehman College, including a chemist, Ed Connelley and his student, Kurt Rainerdson, we looked at how indigenous people take the safrole out of that tea.

We reproduced the tea in the way they made it. And we found there was no safrole in it while in the bark, it was loaded with safrole and the way they did it was to simply boil the water, which degraded the safrole and titrate out the liquid and leave the bark behind. So I'm always just wondering how do people come up with this, you know, and any thoughts on that, Andy?

Andy Weil: Well, you know, one example is Ayahuasca which has become such a prominent psychoactive substance these days. I would never have thought that would happen, but you know, they're advertising Ayahuasca experiences on the streets of Tucson. At any rate, usually in the Amazon, this has made at an ad mixture of two plants, one banisteriopsis B the bark has a psychoactive substance called harmelin in it. But it doesn't really cause any visual changes and most of the native peoples combine it with some other plant, often the leaves of a plant. Has DMT in it. Dimethyltryptamine DMT is a very powerful vision inducing psychedelic, but you can't take it by mouth because an enzyme in the stomach and monoamine oxidase degrades it.

So when anthropologists first reported this and botanists this mixture, they said, well, the, the DMT plant can't possibly have any effect the indigenous peoples always said that this was used to make the visions brighter. And I remember hearing in this class that they found this by trial and error, but when I was in the Amazon cooking up Ayahuasca with shamans, this profusion of plants, it's hard to imagine them saying, well, it's Tuesday, I'll try to leaf today. And when I went. The shamans, how they discover that they could mix these two together. They all gave the same answer and it was that the, that the plant, but banisteriopsis showed them when they were intoxicated on it, this other plant, so that they found it through intuition stimulated by that natural experience.

To me, that makes sense. More logical than the explanation that this was trial and error. So I think that people living close to nature, their intuitive senses of things are much more developed.

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Andy Weil: Mike, I have a practical question for you. What about the issue of intellectual property with regard to this kind of research? Because there's been a history in the past of pharmaceutical companies and others exploiting this indigenous knowledge and then developing products for profit.

And there's not been compensation either in terms of intellectual credit to, or, or monetary credit to the people who that they learn this from.

Michael Balick: Yeah, that's, that's a great question, Andy. In the last. 30 years, really, 40 years starting in the 1980s, people's in our field, ethnobotany, started saying, wait a minute if these contributors are, are intellectually deserving of authorship, they're also intellectually, financially deserving of any benefits that come from this and the first real push came from the National Cancer Institute. We had a collection contract to collect 1,500 samples a year from around the new world, tropics and the, and the person running that contract at the NCI at the time Gordon Craig said, and I want to make this a model of benefit sharing.

And this was again in the late eighties before people really thought about this. So the US government actually pushed forward this idea that people were deserving of compensation. And so over time we developed short-term compensation, medium term, long term, understanding that in a pharmaceutical research project 99.9% of the plants will, will not have an economic yield. So there were short-term benefits. For example, we worked with a company then titled a Shaman pharmaceuticals, now, Jaguar Pharmaceuticals, Jaguar Health, and they devoted a percentage of the cost of the field work to benefit the population and the short term.

So Steve king, one of my graduate students actually used funds and had funds available and would ask the communities where he was working what they wanted. Sometimes it was an airstrip to bring people in and out in an emergency or barbed wire to keep them. Cattle from munching on the forest or a little museum that they could document their own culture.

So the short-term benefits turned out to be really significant. And over the long-term in the case of a Jaguar, a plant that they worked with called Crow. Luckily I or San graded Drago was approved by the FDA for the treatment of of chronic diarrhea and patients that couldn't tolerate their antiretroviral therapies and benefits from the sales are, are now going back to those communities in a lot of different ways. So, but it's not just financial benefits. I think in many places, people are non-monetary they value other things. So when I was working in Belize with the Rosita Arvigo and her husband, Greg Shropshire one of the primary folks that was our teacher was Alejo Ponti Mya healer and an early, early paper that I authored in the authored in the early nineties identifying a plant that had potential anti-cancer value. Don Alejo Ponti was listed as one of the authors on that paper and, and what he did with that paper. Was nailed to the wall of his little house, his modest little house in Belize. And he people would come in and he would show them.

He had about, I don't know, 30 or 40 patients a day. He would show them, he would say, “Soy garanteal”. I'm guaranteed. Look at this, look at this paper, I'm a published scientist. You know, you should pay attention to my wisdom on healing. So it's, it's a lot of different things.

Victoria Maizes: Yeah. And the, one of the things that we still hear sometimes from skeptics is there's no value whatsoever to botanicals now that we have the scientific methods to create pharmaceutical drugs. And yet in integrative medicine, we teach our fellows that there are medicinal plants that benefit human healing in areas where we have no medication. And I'm wondering if you could give an example or two, and then Michael, I'd like to turn to you.

Andy Weil: Well, Victoria, first of all, you know that for years I have argued that that whole natural products with their complex mixtures of constituents have different and often better effects than isolated compounds. For many years I was ridiculed for writing about that and saying that that's really changed.

I think there's been appreciation of the fact that complex natural mixtures are different and valuable and research has changed. One example of what you asked for is milk thistle. Saliva Marianum. This is a nontoxic plant that has the remarkable ability to stimulate metabolism of hepatocytes liver cells and protect the liver from toxic injury.

We don't have anything like that in conventional medicine. And we know a lot of things that damage the liver, including a lot of our medically used drugs. But we don't know anything that protects the liver. This has even been used intravenously as a treatment for deadly Amanita mushroom poisoning.

It's something that you can take. I know students that take this before they go out to drink on an evening. People take it who have, or exposed to toxic volatile solvents, but an extremely useful plant. And we have nothing like that in conventional medicine.

Victoria Maizes: You just mentioned that we're beginning to appreciate the value of whole plants.

And it seems like one of the places where that's coming through really strongly is cannabis, because even the lay people see folks selling, you know, CBD and, and they're somehow reassured there's no THC. And yet, you know, we know that it's the complexity of all these different cannabinoids and terpenoids and you know, other chemicals in cannabis that that gives its, its remarkable healing properties.

Andy Weil: Yeah. That's a particularly complex one with so many different active constituents, but this is the general pattern that plants have mixtures often of related compounds, you know, one might be there and the greatest amount and, and reproduce most of the interesting activity to the plant, but it's modified by all these secondary constituents that we've ignored until very recently.

But as I say, there's really been a shift now in research. And I think also in, in practical knowledge of practitioners.

Victoria Maizes: Yes. And Michael, you were going to add.

Michael Balick: well, no, I was wondering, Andy, can you get intravenous milk thistle extract in this country

Andy Weil: No. Not as far as I know, I think the FDA has not approved it.

Michael Balick: So we do a lot of work with poison information and work with a Poison Information Center in this area. And there always a half dozen people who collect Ammonite mushrooms, mistakenly thinking they're other mushrooms and 96 hours later they're gone

Andy Weil: Or they have a liver transplant.

Michael Balick: Right if they're fortunate enough, but you know, in Europe, you, you get the intravenous milk thistle and you survive with your liver. And there's a lesson there, you know, mother nature has figured this out a long time ago and we're just sort of catching up, which is why we're the primitive ones. You know, there, there, there are 30,000 medicinal plants that indigenous cultures have used and we've only looked at 300, maybe carefully and out of that 300 25% of our prescriptions in your local pharmacy, you know, are based on. So there's a lot more to be done. Maybe we've gotten the low hanging fruit, but now it's time to listen to the wisdom of mother nature.

Victoria Maizes: Michael, you also speak of another fascinating concept that plants can potentially direct activities of people and you, you speak of a concept of calendar plants.

Can you explain what those are?

Michael Balick: Sure. My colleague Greg Plunkett and I, and others work, as I mentioned in Vanuatu in the south, the Southern islands, and there's one island for example, called a night sham island. It's an island of, oh, 700 or 800 people and they have gardens. They grow most of what they consume.

And they, they know to plant their gardens when certain plants flower. So when, when flowers appear on a certain plant, they know it's time to plant yams when they appear on another plant, they know it's time to harvest yams. When the leaves when the needles of Casuarina a large tree turn brown, they know that the sun has shifted and that it's time not to work so hard. You know stay out of the midday, sun it's too intense. So that the plants are telling them something. Oh, since they're island peoples, they live in a marine habitat. And when certain other plants flower, they know it's time to harvest sea urchins or certain fish because they there's more fat there's more meat in the, in the animals, the secret nature. So plants really direct you know people's lives. And in that way, the message plants we also talk about if you, if you are walking through a village and it's not yours in the old days, people might attack you thinking you're a threat. But if you have certain species of plants that you put behind your ear the message is “I come with no threat. I come in peace”. So it's fascinating to study, you know, the implied messages from plants as well as their actual uses.

Victoria Maizes: So it's much more than just attunement with the seasons as certain things come into flower.

Michael Balick: Yes. And also the alignment of the sun, for example, and the intensity of the sun. We have a grant to study indigenous concepts of daylight and its effect on their plants and its effect on their lives in Fiji and Vanuatu.

It’s absolutely fascinating to watch local people observe how the sun impacts their lives and develop rituals to, to, to make rain in other words, to hide the sun. But when they want to plant their crops, things like that.

Andy Weil: Mike, you're a regular lecturer to our classes of fellows at our Center for Integrative Medicine.

And your lectures are much appreciated how much other contact you have with, with practicing physicians. And do you see a greater interaction between ethnobotanist and practice?

Michael Balick: Well, I think the answer is a resounding yes, at many different levels. Next week a group of Fellows in emergency medicine under the wing of Lewis, Nelson who Lewis recently coauthored a book, the handbook of poisonous and injurious plants. They're going to come to the garden for a tour of toxins, poisonous plants to the New York Botanical Garden. And We get a lot of questions from emergency departments about what's this plant what's that plant. We can't offer advice as I say, my patients are green, but we can offer a determination of the species to allow the emergency room physician to move forward or not with the intervention.

Michael Balick: At the same time. You know, New York city being a immigrant community. We do a lot of work with the Dominican community, for example, and have for many decades Dominican's use medicinal plants and they also go to clinics and emergency departments when the when they're seeking help.

Now, the physicians in the emergency department or in the hospitals don't always understand plants and they don't understand what their uses are and what people are attempting to treat. And so again, my colleague Ina Vandebroek coordinates the program to teach physicians in our area cultural competency and dealing with a patient use of plants. So training physicians to be respectful, to be understanding, to speak the language of plants and to be able to have an interaction with the particular immigrant group about what they've been using and how they can then alter their treatment accordingly. So lots and lots of contact with physicians and healthcare providers.

Victoria Maizes: So it gets me to a final question, which is what do each of you see as the future potential of plants in medicine?

Andy Weil: Well, I think it's tremendous. I think there is enormous value to plant medicine. And I think this can go on side by side with pharmaceutical medicine. Our pharmaceutical drugs are often very valuable for the management of, of acute conditions of when the body is severely out of balance for getting them back in a balanced state.

When used long-term, their negative effects often outweigh the benefits toxicity. The potential in long-term use to actually prolong or worse and conditions. And I think that the botanical preparations are much safer and often have. A better quality effect. And I'd love to see these both available to physicians and patients.

And that doesn't mean just making herbal teas. I mean, we might be able to make a whole botanical extracts, for example in standardized form that physicians would be comfortable using. But I think there's a tremendous need to educate physicians about this world. And our center is certainly, you know, doing what we can to bring people up to speed.

Michael Balick: You know, I do a lot of work in the Pacific where the clinics are rather bare because the field ship comes in once every six months. But growing around the clinics are gardens. That are filled with medicines, and we've worked with a number of island nations to develop primary healthcare manuals based on plants, working with the local departments of health and leading physicians.

And so I remember a person in, in Pohnpei Mary David during a cholera epidemic she was in her seventies, maybe eighties at the time. She was living near one of the village clinics and they had run out of medicine for the treatment of diarrhea. And she was waving this branch at me and said, but these kids, my grandchildren, who are the medical officers who were trained overseas, they don't remember that I would give them this plant, the guava tree when they had diarrhea. And isn't it a shame that they're turning patients away. So that was actually the idea to develop these primary health care manuals. And then diabetes is a, is a huge problem in the Pacific amongst other primary public health issues.

And one of my graduate students, Christopher Kidlong, along who Andy knows, well for his dissertation, he worked on. And the called and the Thymelaeaceae family. But they call it mother of all medicine in Palau Delalakar (Phaleria nisidai) and they did a clinical trial. With a group of physicians both local and international, and they found that drinking a tea of this plant twice a day combined with exercise and diet substantially reduced hemoglobin A1C at no cost to the patient.

In other words, it's a sustainable therapy. And because there was a randomized, double blind placebo-controlled trial, they parsed out the diet and exercise and the tea alone knocked the hemoglobin A1C down 0.6 in just 12 weeks. Now the other issue with Delalakar with this plant, it's sort of an entourage effect, I guess, of compounds because it also gives you energy.

So the patients, the participants in this pilot clinical trial said, well, they had more energy to exercise and they weren't as hungry. So the reduction in hemoglobin A1C in this 12 week period was extraordinary. And it was from a plant that grows in everybody's yard.

Victoria Maizes: I like to think of that as side benefits, as opposed to side effects, you know, the side benefit of additional energy to be able to then do the additional behavior.

Michael Balick: Yes. And one of your colleagues and former fellows, Steve, Dr. Steven Dahmer was with us on one of these trips to Palau, and he was trying dala la car as a tea and he just noticed that it was an energizer. You know, he, he reported that as one of its positive effect. So we, we've also tried to train physicians Dr. Roberta Lee, another one of your former fellows and colleagues and I put together an ethno-medical training program that we implemented in Palau and brought healthcare professionals into the Pacific islands to get firsthand experience and learning from our elders.

Victoria Maizes: Well, Michael, thank you so much for your more than four decades of work in ethnobotany for training physicians, so that they have a greater awareness and obviously more tools at their fingertips and for all of the work you do thank you for teaching at our center. And it's wonderful to be on the podcast with you.

Michael Balick: Yes, indeed. Well, thank you very much. I I've just so enjoyed my interactions with the center and all of the people that we've trained and all of the people that we've taken to the field and studied with. And, and it's just been a joy for me to watch the evolution of integrative medicine from those earliest days where people were saying we can't study this. How do you do placebo acupuncture? It's impossible. To the days today where these are mainstream therapies. So congratulations to you, both. And you know, I do treasure our friendship and look forward to lots of things in the future.

Victoria Maizes: Thank you, Michael.