knowledge and discovery traditional practice future wisdom
TRANSCRIPT
• Explained the differences between the Ocimum species.
• Most of the samples kept as Tulsi (Ocimum tenuiflorum) may actually be Ocimum gratissimum (ID confirmed by Allan Patton, Kew)-This has been confirmed by the DNA analysis.
• Confirmed the samples which are not like any of the Ocimum samples were a different species, most likely a weed which has contaminated the soil.-Soil was autoclaved but the weed still managed to germinate.
Tulsi in the UK
Verification of Ocimum samplesA Celebration of Herbal Medicine History: researching botanical
knowledge and discovery
Traditional practice – future
wisdom? Quality, safety and
evidence of herbal medicines from
an ethnopharmacological
perspective
Michael Heinrich
Pharmacognosy and Phytotherapy,
UCL School of Pharmacy, 29 - 39 Brunswick Sq.,
London, WC1N 1AX, UK (England)
The grand developments today include:
• Fast urbanisation with about 55% of the world’s
population living in cities
• Dramatic socio-economic changes including
nutritional changes
• The aging-population resulting in increased
demand on health services and a shift in health
care challenges to chronic and degenerative
diseases
• Improved, but inequitable access to health care in
many but not all regions of the world
• Global network of goods and services with often
poor quality assurance
2
3Age-standardised mean BMI in girls (children and adolescents) in 1975 and 2016 (Lancet 2017)
Body Mass Index – changes over 30 years
4Age-standardised mean BMI in boys (children and adolescents) in 1975 and 2016 (Lancet 2017)
Body Mass Index – changes over 30 years
Trends in age-standardised prevalence of BMI
categories in children and adolescents
(Children and adolescents were aged 5–19 years).
Male children and
adolescents
Female children and
adolescents
Age standardised prevalence of obesity
6
Herbal Medicines
in the Global
South – Who
wants to know?
Herbal medicines and
ethnopharmacology
Zapotec
herbalism, Mexico
Mixe health
rituals, Mexico
Cho’rti rituals,
Guatemala
From a macro- to the micro-perspective
8
Is this still the field site to study ‘traditional
knowledge (Popoluca region, México 2000)
9
The Ch’orti’ of Eastern Guatemala
• Ch’orti’ Maya mainly live in hamlets, (culturally non-indigenous) “Ladinos” in towns
• Studied by C. Wisdom (1930s), unpublished MS on plant use
Ch’orti’ area
Ethnobotany of a Mayan group
Kufer, Poell, Foerther & Heinrich (2005) J Pharm Pharmacol 57: 1127–1152
10
Guatemala as tourists “know” it
11
An Ethnobotanist’s view of Guatemala
12
Methods
• Total of 17 months of fieldwork, resident in town, visits to hamlets
• Licences for research and plant collection
• Collection and identification of voucher specimens
• (Semi-) Quantitative data: semi-structured interviews
• Qualitative data: unstructured interviews, participant observation
• Interviews mostly in Spanish, some in Ch’orti’ with interpreter
• Selection of 40 interviewees :
– plant knowledge main criterion
– Active search for informants
13
Doña Balbina, a traditional healer (divining cause ofsoul loss for patient)
Juana Pérez (engaging in self-treatment)
Plant knowledge and usedo not depend on specialist healer status
14
Analysis of data
• (Semi-)quantification
• Separation into ten use groups based mainly on body system
• Comparison with uses in other regions of Guatemala and adjacent countries
• Analysis for a different variables:
- introduced/native
- comparison with 70 year old MS by Ch. Wisdom
• Analysis of current bioscientific knowledge about
most popular species
15
Charles Wisdoms’s manuscript
• A detailed unpublished MS (Field Museum Chicago) by an US-American anthropologist Charles Wisdom documenting plant uses among the Ch’orti’ Maya in the 1930s offers an exceptional opportunity to explore questions of continuity and change in Maya medical ethnobotany.
• His classic “The Chorti Indians of Guatemala”.
• While it is unfortunate that he did not collect any voucher specimens of the plants whose uses he documented, the MS benefits greatly from tentative plant identifications provided by the leading expert on the flora of Guatemala of his time, Paul Standley, based on vernacular names and descriptions. It seems from the data, though, as if Standley was more familiar with local plant names and uses in other parts of Guatemala than in the eastern part.
16
Plant species Total URs vers
Citrus limon (L.) Burm. 96 10
Matricaria recutita L. 54 9
Chenopodium ambrosioides L. 54 5
Tecoma stans (L.) H.B.K. 46 7
Buddleja americana L. 43 5
Allium sativum L. 41 9
Citrus sinensis (L.) Osbeck 37 7
Ruta chalepensis L. 36 6
Nicotiana tabacum L. 32 9
Pluchea symphytifolia (Mill.) Gillis 32 5
Introduced Native
Most frequently cited species (top 10 of all use groups in our ethnographic data)
vers = versatility(number of use groups)
17
Historical data
• Unpublished MS by US anthropologist Charles Wisdom
• List of 648 entries, 356 with medical uses
• Basic unit of information: entry/plant species (Plant uses)
• No historical voucher specimens - botanical identification by botanist Paul Standley based on vernacular names and description → Botanical
authentication essential
169
51
5680
Misinterpretedby Wisdom
More detailedID achieved
ConfirmedWisdoms ID
Noinformation
9 47
78222
species
genus
family
not botanicallyidentified
Level of botanical identificationmedicinal plants
Quality of botanical identificationmedicinal plants
N = 356
18
A comparison
Historical and modern ethnobotanical
data• 29.1% of all contemporary MPUs overlapped with
the historical data, i.e. the same plant taxa were mentioned in Wisdom’s MS as being used for treating conditions in the same use group
• A further 42.7% of cMPUs = species which are recorded in the MS as medicinals, but for treating conditions of a different UG (OUG).
• 12.8% of all cMPUs = plants with an entry in the MS, but no record for medicinal use (NMU),
• 15.4% of plant species’ cMPUs have no entries in the MS (ABS).
24
Comparison of today’s and historical data
29%
42%
11%
18%
47%
34%
9%
10%
Same UG
Other UG
Nonmedical
Absent
inner circle: plant uses
outer circle: use reports
The most widely
used species are
more likely to be
found in Ch.
Wisdom’s MS
Without proper and full botanical
documentation and authentication
any study on medicinal plants
remains preliminary
Fast forward – Guatemala in 2019
Green health: improving indigenous
participation through the CBD's ABS (Access and Benefit Sharing Mechanism of the Convention on Biological Diversity)
❖This project is funded by the Darwin
initiative, a funding scheme of the UK
government which supports local projects
for the conservation of biodiversity and
the environment in general.
❖Location: Guatemala, Petén region
❖Major ethnic group: Qeq’chi’
❖Overarching aim: implementation framework for
sustainable use, access and benefit-sharing in
Guatemala involving consensus between
indigenous groups, government, academia and
industry, based on natural capital and traditional
knowledge to sustain healthy livelihoods.
❖The CBD’s main objectives are all related to the future of the world’s biodiversity’: CONSERVATION, SUSTAINABLE USE, FAIR AND EQUITABLE SHARING OF THE BENEFITS ARISING DERIVED FROM GENETIC RESOURCES
❖The Nagoya protocol attempts to regulate access and benefit sharing (ABS) to support the implementation the ‘fair and equitable sharing of the benefits arising out of its uses’
❖Difficulties in applying the principles of the Nagoya protocol – inconvenient for businesses? Unfair to locals? Too complicated for institutions?
❖How can we ascertain that benefits are equitably shared? → Agreements, through discussions, TransDisciplinary workshops
Jumping to the UK (2019) – Herbal
Medicines – Who cares?
28
Aim: To gain insight into the
public’s perception of herbal
medicine/ general use of herbal
medicines for health care, as well
as on the growing of plants for
medicine.
29
Why are respondents attracted
to herbal remedies? (N=307).
Online Survey 2018 (UK):
• Covered participants’ views
about herbal medicines.
• Survey responses were
categorised and analysed
using Qualtrics
• 408 participants (numbers
varied across questions)
• Herbal medicines are
popular, particularly amongst
the 36 to 55 year old age
group.
• Used herbal medicines for
minor-self-limiting conditions.
• Herbal medicines are
‘natural’ and ‘have fewer side
effects’.
UK: Herbal Medicines. Who Cares?
Lazarou and Heinrich 2019
Phytother. Res.
30
Use herbal remedies for groups of
health conditions (N=324) -
multiple answers possible
Online Survey 2018 (UK):
• Covered participants’ views
about herbal medicines.
• Survey responses were
categorised and analysed
using Qualtrics
• 408 participants (numbers
varied across questions)
• Herbal medicines are
popular, particularly amongst
the 36 to 55 year old age
group.
• Used herbal medicines for
minor-self-limiting conditions.
• Herbal medicines are
‘natural’ and ‘have fewer side
effects’.
UK: Herbal Medicines. Who Cares?
31
"In general, herbal remedies are
effective for minor health
conditions" (N=144)
"In general, herbal remedies
are effective for major health
conditions" (N=144)
UK: Herbal Medicines. Who Cares?
32Lazarou & Heinrich 2019 Phytother. Res.
UK: Herbal Medicines. Who Cares? Main kitchen plants
used in healthcare (
33
Medicinal plants commonly grown at home
34
Response No. selecting
this answer
% of
Participants
I don’t know 64 21.1
I trust the supplier 30 9.9
I see if it works 49 16.1
Packaging 5 1.6
Smell, colour and taste 23 7.6
THR 10 3.3
Research 27 8.9
Using suppliers that use good manufacturing
practice (GMP)
7 2.3
Brand reputation 31 10.2
Reviews/ word of mouth 37 12.2
1
How do you know if a herbal product is of good or bad quality
(N=304
Informal interviews showed that
people were unaware of how
poor the quality of some products
are on the market, which could
perhaps be why THR was so
lowly valued.
Do people tell their doctor of pharmacists about using
traditional remedies? (British Indian)
0
10
20
30
40
50
60
70
80
90
Doctor Pharmacist
Nu
mb
er o
f p
art
icip
an
ts
Yes
No
Not applicable
Of the total research population, 106 participants who took
prescribed medication were asked if they told their doctor or
pharmacists about the concurrent use of traditional remedies.
Telling healthcare professionals?
Bhamra et al 2019.
Phytotherapy
Research
36
St. John’s Wort and its
variable quality
Lanzhou China, May 2016
37
[FS1]
Fingerprints of 47 St. John’s Wort samples (commercial products) organised by
similarities in the fingerprint under UV 366 nm after derivatisation: images under
UV 366 nm after derivatization with NP and PEG;.
Rutin (Rf = 0.1) and hyperoside (Rf O.28) left side = extra band at RF 0.48
The challenges of good quality: St. John’s Wort
Key findings from the HPTLC analysis• 48 samples (mostly commercial products)
investigated
• All THR / licensed samples (except sample 8)
show a flavonoid fingerprint in compliance
• Sample 8 shows an additional yellow zone due to
avicularin but also the yellow zone underneath
chlorogenic acid
• 26 samples show a fingerprint in compliance with
the USP description
• 11 samples show an extra yellow zone at RF 0.49,
due to avicularin
• 8 samples show a faint fingerprint with and without
avicularin,
• 2 samples show a very weak fingerprint.38
Food dyes in unlicensed SJW preparations
39
Samples 11, 13, 17, 23, 24, 28, 31, 40, and 46 contained food dyes, identified as Brilliant Blue (E133; Rf = 0.1 ), Sunset Yellow (E110; yellow zone at Rf = 0.35 ), Amaranth (E1023; pink zone at Rf = 0.58), and Tartrazine (E102; very faint yellow zone above Amaranth at Rf = 0.65).
Image under white light, after development (no derivatisation).
Food dyes in unlicensed SJW preparations
40
Samples 11, 13, 17, 23, 24, 28, 31, 40, and 46 contained food dyes, identified as Brilliant Blue (E133; Rf = 0.1 ), Sunset Yellow (E110; yellow zone at Rf = 0.35 ), Amaranth (E1023; pink zone at Rf = 0.58), and Tartrazine (E102; very faint yellow zone above Amaranth at Rf = 0.65).
Image under white light, after development (no derivatisation).
All but two are samples
sourced via the internet and
are produced / commercially
available in the USA
There are numerous bottlenecks along the complex value chains of HMPs, which may result in poor quality products.
Registered / Licensed products have to comply with the regulatory requirements providing better patient safety
Key is the traceability along the value chains based on an
understanding of the materia prima:
Future vision - blockchain
Should we set a place for blockchain systems
Heinrich et al. 2009 Frontiers in Pharmacology (Ethnopharmacology)
• Blockchain systems are a fast emerging and a currently
widely discussed novel strategy for a decentralised
cryptographically-enhanced digital ledger recording
transactions among stakeholders. In essence they are a
form of digital book keeping.
• The may offer novel solutions for some of the key
challenges in herbal medicine supply: Quality /
authenticity, sustainability of the supply, equitable benefit
sharing and thus ultimately traceability from the primary
production to the products used.
• They can be based on simple (mobile phones) or
complex tools (phytochemical analysis)
• This follows up on our paper on the role of value chains in
ethnopharmacology (Booker et al 2012, J.
Ethnopharmacol.)
Key Challenges at each stage
Level of Complexity of the Blockchain
solution
Specific Benefits General BenefitsStage in the
Botanical Value Chain
• Ensure best practice (GACP) and sustainability
• Verifiable payment• Primary producers - benefits
• Obtaining high standard products
• Certainty of sustainability and equitable benefits
Blockchain
Cultivation and Collection
Primary Processing
Manufacturing
Retail
Consumer Incre
ases T
rustw
ort
hin
ess
Local E
conom
ic b
enefits
Tra
nspare
ncy (
consum
er)
Tra
ceabili
ty a
nd G
xP
• Ensure correct and clearly described procedures - SOP
• Minimising risk of contamination
• GMP – compliance and ascertaining Quality control
• Understanding of the underlying supply system
• Costs of acquiring technology
• Training for technology use
• As above plus• The need to capture the
technical complexities
• As above plus• Differences between
regulated and unregulated market elements
• The need for transparency towards consumers/patients
• Understanding of benefits
• Understanding of the underlying supply system ascertaining consumer trust
Should we set a place for blockchain systems
Heinrich et al. 2009 Frontiers in Pharmacology (Ethnopharmacology):
https://www.frontiersin.org/articles/10.3389/fphar.2019.00396/full
Conclusions
Herbal
Medicines
Claims, Efficacy and pharmaco-
logy / pharmaco-
kinetics
Quality, variability and safety
Knowledge and practice on the use of herbal
medicines
Sustainable sourcing (value
chains) and benefits
Ethnopharmacology
Future
wisdome:
Herbal
Medicines
Claims, Efficacy and pharmaco-
logy / pharmaco-
kinetics
Quality, variability and safety
Knowledge and practice on the use of herbal
medicines
Sustainable sourcing (value
chains) and benefits
Ethnopharmacology
Future
wisdom:
All health care professionals
including herbalists need to
engage with today’s challenges
and opportunities
• Herbal medicines and foods must be recognized as a global health care opportunity
• Herbalists have a role to play in the prevention and treatment and will so in the future, but we must get much better trained practitioners
• We can improve their use using science-based approaches
• Quality is requires much better (self-) regulation
Thank you Francesca Scotti, Katja Loebel, Anastasia
Agapounda, Tony Booker……
The team in Pharmacognoy and
Phytotherapy
Dr. Deborah Johnston, SOAS, London
Funding: W. Schwabe (charitable
donation), who have had no influence on
the design of the experiments and the
interpretation of the data
Acknowledgements ❑ Dr. Suky Bhamra, with collaborators in
Leicester❑ Tony Booker, Johanna Michl (LSoP)❑ Prof. M. Simmonds and collaborators
(Kew) Dr. Stefan Wanke, Prof. G Vollmarand Dr. Oliver Zierau (Univ. Dresden)
❑ Dr. Abdul Koshak (now Jeddah) and collaborators
❑ And the many others students who contributed to projects.
Funding❑ Leverhulme Trust, Bloomsbury
studentship. Saudi Arabian government