There’s always a cost. In the case of ginseng as an herbal remedy, the largest cost is very likely not its symptoms to the user. I read an article earlier on NPR about the effect of wild ginseng harvesting on our National Parks, highlighting the effect it has on ecology, the risk of American ginseng extinction, and the impact of its poaching on individuals and communities. Ginseng is selling for ridiculously high prices in Hong Kong, up to $20,000 per pound. For the poacher here in the eastern United States, that can mean selling their prize for over $200 per pound, a healthy income for some in rural Appalachia. But it can also mean 5.5 months in federal prison in the case of Billy Joe Hurley who was convicted multiple times for ginseng poaching. The reason for the high selling price for american ginseng is not that it is a culinary treasure over in southeast China, instead it is viewed as an herbal remedy for many ailments and diseases. And the reason that it isn’t simply cultivated is that the delicate forest ecosystem is difficult to mimic and mechanize. With ginseng selling for such a high price and having a tremendous impact on people’s lives and the ecosystem of the Appalachian Mountains, I wondered whether this is all worth it.

I searched for the effectiveness of ginseng as an herbal treatment and was rather disappointed. The research truly is minimal, and that which has been researched shows inconclusive or minimal effects. The NIH acknowledges that ginseng is possibly effective for two indications: diabetes and cold symptoms, and acknowledges that the research supporting these is very limited. For all other diseases and symptoms, it is currently considered ineffective. The reality is, we don’t know enough to say if ginseng is effective for anything, and we do know enough to say that it is ineffective for many conditions for which it is currently being marketed.

Unfortunately, this kind of macrocosmic side-effect of alternative medicine is not occurring in isolation. The northern white rhinoceros in central Africa was driven to functional extinction in the last decade because of belief in healing power of its horn.

In my first months in med school, I have received a lot of flak because of my unwavering commitment to evidence. To explain, it’s not that I wouldn’t implement treatments with no evidence for them. Much of medicine doesn’t have great evidence, but instead has case studies and proposed and reasonable mechanisms. Rather, I wouldn’t prescribe a treatment in the care of a patient that has overwhelming evidence against it, including common prescriptions and alternative treatments alike. This doesn’t seem like a far-fetched idea to me but I have learned it is not unanimous.

In reality, we must always analyze anything, including medical treatments for the cost and the benefit. And we must expand our views of side-effects to include not only the impact on the patient, but on the world as a whole. The fact is, the northern white rhino is gone because of our unwavering tolerance in outdated rituals, the Appalachian Mountains are becoming a little less pristine because of the belief in the medicinal uses of ginseng, and people are being imprisoned because of the black market created by alternative treatments. There is always a cost, always. And while this is an extremely complex social, cultural, and financial issue that’s not simply going to end with a few articles, I firmly believe the first step is to start the discussion on why this is happening and what we can do to fix it.