Daniel E. Moerman

Social Impact Statement: Global change endangers the terrestrial vegetation that sustains us. Therefore, policymakers need to make informed decisions about what and where to protect. However, with limited resources, we must decide whether to protect the intrinsic value of plants or their value to humans. Protecting both is possible. By investigating the distributions of over 3000 of Canada's useful native plants defined in ethnobotanical databases, we identified areas that are essential in harbouring plant benefits. Here, we bridge biodiversity with the benefits it provides to inform conservation policies by prioritizing plant species. Summary: Plants are foundational for ecosystems and provide essential services to humans, but little is known about the distribution and protection about useful plants. Here, we address how well the biodiversity of all plants captures the diversity and conservation status of plants that provide human uses. We calculated diversity metrics for plants in Canada at 1‐km ² spatial scale based on species distribution models and a large plant‐use database for use categories of food and feed, medicinal, biochemical and genetic resources and materials. We used the Species Protection Index (SPI) to determine whether species are adequately represented in protected areas and derive a new index—Useful Species and Globally Endangered (USaGE)—to identify important species for conservation based on the combination of metrics of usefulness and (USa) metrics of extinction risk (GE) obtained from the Committee on the Status of Endangered Wildlife in Canada (COSEWIC) species assessments. Overall, c. 30% of native plants has documented uses, and plant richness is correlated with useful plant richness. Useful plants are generally concentrated in southern and agricultural areas, with the exception of some use categories (e.g., medicinal plants are also prevalent in coastal and boreal regions). Around 94% of useful species are inadequately represented in Canada's existing protected areas, including many important USaGE species like American Ginseng. Our combined approach identifies priority species and areas in need of conservation that have a long and extensively documented record of potentially providing ecosystem services to humanity.

St. Helena is a beautiful place. The first impression one gets, even on arriving from the Middle West, is of an almost oppressive flatness of the land, unrelieved by the tiniest hillock anywhere. But as soon as one becomes aware of the marshes, he loses his desire for physical relief. The marsh is the source of the island's life. For miles in every direction the great sea of marsh grass undulates in the ocean wind, green in summer, brown in winter, always moderating and containing the powers of the daily tides, twice low, twice high. The thousands of tons of grass are the basis for the marine food chain, providing shelter, refuge, and food for the eggs, larvae, and infants of a multitude of different marine species. The marsh is divided by hundreds of tidal creeks of as many sizes and shapes, changing their direction of flow every six and one-half hours. The marsh and its creeks are the home of a great variety of birds and animal life. There is no doubt that it is the marshes which make the most lasting impression on the stranger here; perhaps most telling, and yet the hardest to describe, is their smell, a deep fertile, fresh and almost exhilarating odor, clearly a mixture of both the smells of death and new life, which, in the marsh, are so clearly complementary processes.

Background and aim: Despite recent publications, practitioners remain unfamiliar with the current terminology related to the placebo and nocebo phenomena observed in clinical trials and practice, nor with the factors that modulate them. To cover the gap, the European Headache Federation appointed a panel of experts to clarify the terms associated with the use of placebo in clinical trials. Methods: The working group identified relevant questions and agreed upon recommendations. Because no data were required to answer the questions, the GRADE approach was not applicable, and thus only expert opinion was provided according to an amended Delphi method. The initial 12 topics for discussion were revised in the opinion of the majority of the panelists, and after a total of 6 rounds of negotiations, the final agreement is presented. Results/recommendations: Two primary and mechanism-based recommendations are provided for the results of clinical trials: [1] to distinguish the placebo or nocebo response from the placebo or nocebo effect; and [2] for any favorable outcome observed after placebo administration, the term “placebo response” should be used, and for any unfavorable outcome recorded after placebo administration, the term “nocebo response” should be used (12 out of 17 panelists agreed, 70.6% agreement). The placebo or nocebo responses are attributed to a set of factors including those that are related to the medical condition (e.g. natural history, random comorbidities, etc.), along with idiosyncratic ones, in which the placebo or nocebo effects are attributed to idiosyncratic, or nonspecific mechanisms, exclusively (e.g. expectation, conditioning, observational learning etc.). To help investigators and practitioners, the panel summarized a list of environmental factors and idiosyncratic dynamics modulating placebo and nocebo effects. Some of them are modifiable, and investigators or physicians need to know about them in order to modify these factors appropriately to improve treatment. One secondary recommendation addresses the use of the terms “placebo” and “nocebo” (“placebos” and “nocebos” in plural), which refer to the triggers of the placebo/nocebo effects or responses, respectively, and which are inert agents or interventions that should not be confused with the placebo/nocebo responses or effects themselves (all panelists agreed, 100% agreement). Conclusion: The working group recommends distinguishing the term response from effect to describe health changes from before to after placebo application and to distinguish the terms placebo(s) or nocebo(s) from the health consequences that they cause (placebo/nocebo responses or effects).

We provide a new perspect ve with which to understand what for a half century has been known as the »placebo effect.« We argue that, as currently used, the concept includes much that has nothing to do with placebos, confusirig the most interesting and important aspects of the phenomenon. We propose a new way to understand those aspects of medical care, plus a broad range of additional human experiences, by focusing on the idea of »meaning,« to which people, when they are sick, often respond. We review several of the many areas in medicine in which meaning affects illness or healing and introduce the idea of the »meaning response.« We suggest that use of this formulation, rather than the fixation on inert placebos, will probably lead to far greater insight into how treatment works and perhaps to real improvements in human well-being.

Symbolic healing, that is, responding to meaningful experiences in positive ways, can facilitate human healing. This process partly engages consciousness and partly evades consciousness completely (sometimes it partakes of both simultaneously). This paper, presented as the Society for the Anthropology of Consciousness Distinguished Lecture at the 2011 AAA meeting in Montreal, reviews recent research on what is ordinarily (and unfortunately) called the “placebo effect.” The author makes the argument that language use should change, and the relevant portions of what is often called the placebo effect should be referred to as the “meaning response.”

My first introduction to something that might be called “medical anthropology” occurred in 1969, although at the time, I had never heard that phrase. I was doing fieldwork on St. Helena Island in South Carolina as part of my Ph. D. work. St. Helena is a barrier island, just across the Broad River to the north from much better known Hilton Head Island. Interested in family organization in a black community (debates raged in the 1960s about “the black family”), I thought that a thorough investigation of such families in a real community would be worthwhile. As I pursued my genealogies and spoke with these kind people, I heard an occasional reference to the use of certain plants - they called them “weeds” - to treat various illnesses. Intrigued, I pursued the matter, and found a number of people eager to talk about it. Eventually, I was able to identify three dozen or so “weeds” that were part of everyday use; most were better known to older than younger Islanders, but most everyone knew something about it. The whole matter seemed very odd to me; today, surrounded by “health food” and “natural medicine” shops, with everyone taking Echinacea to stimulate his or her immune system, and Gingko to ward off Alzheimer's disease, it doesn't seem so unusual to hear about medicinal plants, but in the 1960s, it was odd indeed. I wondered if anyone else had ever used those plants for anything, and did they work?