‘Irish people love taking drugs . . . We can’t get enough of them’

Dr Dilis Clare lugs up some unceremonial looking tupperware buckets and invites me to sniff inside. Hawthorn, notoriously, is variously said to smell of sex, decaying flesh and gangrene. To me it is sweet and musky.

She opens another. “This is called the ‘bread and butter plant’ as the leaves used to be put in the sandwiches,” she says. “Why? It’s green, it’s nutritious, it’s good for the heart and also it is a food. A lot of the herbs can be used for prevention or higher doses, like in a tincture or tea, can be used medicinally. There is a food/herb overlap.

I'm in her herbal dispensary, health shop and doctor's surgery on Sea Road in Galway, where Clare, a herbalist who is also a fully trained and qualified GP who also lectures in NUI Galway, has been based for more than 15 years. "I have huge confidence in tea; a tea is simply dried herb. This is the hawthorn as you walk your hedgerow, this is the combination of the leaves and flowers. Smell it."

These are the dried herbs she uses, but she also makes and dispenses tinctures, which are popular in western herbal medicine. A tincture, she explains, is made by mixing one litre of alcohol with four litres of water and a kilo of herb, to make a one-in-four solution. Most tinctures are made between one in three and one in five.

She lifts the lid on a bucket and asks me what’s inside; I smell the rose petals before I even see their distinctive flowers. “All roses derive from the dog rose, the wild rose. I use rose petals for people who have had a difficult childhood. You can’t smell a rose without believing in a benign universe; it just lifts the spirits.”

How do we know this?” she asks playfully and then, with an almost curt dismissal of herself: “Because we all know it. It is not a mystery. In the hard times in Ireland, we could have used more rose petals.”

I think of the past few summers at the War Memorial Garden across from the Phoenix Park, where I eventually gave up caring what people thought about being the lone oddball smelling all the roses. I linger over the petals and then, when I’m ready, move on to the next smell. “Eyebright has a grassy smell. It grows all along the back prom in Galway, which is by the golf course.”

Herbs have multiple constituents and multiple actions, she says.

Eyebright is used for treating eye infections. It’s called eyebright because it has a tiny flower on top which looks like eyelashes with a bright iris. This is based on the doctrine of signatures, developed in ancient Greek medicine, that some herbs look like various parts of the body and that God had designed them this way to show how they could be useful to us. Needless to say, it’s a totally human-centred worldview and it’s widely discredited now. But it’s why eyebright is used for eye infections, lungwort for lung infections and toothwart for tooth ailments.

“We have to imagine a world where the sun, moon, stars, the dark and the animals were central to and deeply embedded in our experience. We lived close to nature, where everything was interpreted as being immediate and the knowledge was handed down through stories as well. Ireland is very influenced by colonialism, so it became seen as poor people’s medicine, as ignorant medicine. People chopped themselves off from it as soon as they could afford to.”

We go upstairs to her office, which is dotted with books on herbs and medicine. She has index upon index outlining how herbs can interact with prescribed medicines.

This is where she meets her patients. On a first consultation, they will spend an hour or more with her. Here, they tell her their story: how they eat, how they sleep, what ails them, what has worked for them, what hasn’t. It allows the herbalist build up a deep understanding of the patient; it also, she says, allows the patient to really understand themselves and their own story, for it’s only when we talk out loud that we understand what is happening to us. This is known as “narrative medicine” and Clare is a firm believer in it.

Opponents of herbal medicine say it is not as effective as pharmaceuticals and can even be dangerous. “In 17 years of clinical practice as a herbal physician, I have witnessed no reports of serious or irreversible or long lasting side effects or consequence using the herbs in my clinical practice,” Clare rebuts.

As a GP and herbalist, she’s an oddity, and while some doctors might recommend herbal remedies (echinacea and wild oats being common), there don’t seem to be any GPs who are practicing as a herbalist.

"To do this, I had to give up a very rewarding practice in the UK and my NHS pension," says Clare. "This was a serious decision. I love logical and rational medicine and rational approaches to the problem, but sticking drugs on top of abnormal physiology does not always make sense. All drugs have side effects. If you can treat things without drugs and particularly if you can treat them with herbs that are close to foods, such as marigold, camomile, nettles and wild oats, why wouldn't you?"

There was no distinction between medicine and Western herbal medicine until the onset of biomedicine and pharmaceuticals, she says. “What I learned in medical school was the same as what I learned in my clinical training for herbal medicine. The same exam; the same understanding of blood results, pharmacology and physiology.”

When she studied herbal medicine, Clare says, she made sure that was trained by four herbalists. “I’m a sceptic. I wanted to see if they agreed with each other, if there was consistency. They were rock solid.” She is now an honorary clinical fellow at NUI Galway, where she teaches medical students.

The science of herbal remedies is crucial, but so is the meaning they hold for people. I ask Clare what she thinks of traditional Chinese medicine. “It’s very good for Chinese people,” is all she says, but the implication is clear: a big part of the success of herbal remedies comes down to the belief people have in them. Or, if you want, call it the placebo effect.

“Placebo is a dirty word,” says Clare. “Medicine doesn’t have to be pitched against herbalism. They each have a role.”

Would she never just take a paracetamol for pain? “Oh yes,” she says, and tells of how only pharmaceutical medicine could have helped her with a blood clot she got while pregnant. It keeps diabetics alive, is essential for fighting serious bacterial infections and has saved the lives of millions who would otherwise have died of Aids.

“I don’t believe in practising medicine according to ideology. I believe in practising the medicine that a patient needs. People come to me because they want to try a natural remedy and sometimes it is my job to say that I can’t use herbs to turn it around. I can help someone with an early diagnosis of high pressure, or give them herbs which can sometimes help them to get a better effect from their drugs.”

Clare uses both conventional medicine and herbal medicine. “Irish people love taking drugs,” she says. “We can’t get enough of them. We pass them over the garden wall.”

Herbal medicine is not for everyone, she says. “A lot of people go for the first appointment and they don’t come back. They expect medicine, maybe an antibiotic, and that they will get better. It’s not always a good match and this is frustrating for me and for them. I tell people if they are not prepared to change or possibly take medicine for a moderately long time – as a rule of thumb, maybe a month for every year you have had a problem – then you are wasting your time and mine.”

But she is confident that attitudes are changing. “There are so many people now who realise the limitations of drug medicine, and there are also limitations to herbal medicine. We don’t think there is only one way to learn and we don’t think there is only way to make an omelette. So why is there only one approach to health?”

After 16 years, she is starting to wonder what the next 10 years should be about. “There are all kinds of challenges and one is to support the training of medical herbalists, primarily because there are so many patients now on drugs and it is important to get a good grounding in pharmacognosy now.”

Being a lone voice can be frustrating because so many people don’t have the choice, she says. “The only choice they’re given is too toxic for many of the conditions it is used for, such as antibiotics and steroids. Medicine is concerned with disease, not health. The biomedical approach is that people wait until their health is so bad that it needs a drastic action.”

“It is not a 1930’s relic that nobody does anymore. It is being resurrected in terms of cooking, foraging and medicine. Medicines are based on traditional knowledge and constituent knowledge. It is alive and living, with hundreds of patients coming in.”

But she knows there are dangers. “There is a big difference between empowering people to look after themselves with herbs as they would with a first aid kit, and teaching people how to know when to go for professional advice and to value that professional advice. I don’t have the answer. I’m still trying to figure it out.”

She has one last piece of advice as I leave: “Collect some nettles from the local park, from the back of the shrubs where they’re not sprayed, and put them in the teapot. Make sure you eat the essential fatty acids, especially fish oils. And eat seven portions of fruit and vegetables a day.”