Transcript Dosage of enalapril for congestive heart failure in USA

Medicine quest
Mark Plotkin PhD
President
Amazon Conservation Team
Arlington, VA
What is ethnobotany?
Ethnobotany
the study of how people of a particular culture and
region make of use of indigenous plants
the exploration of how plants are used for such things as
food, shelter, medicine, clothing, hunting, and religious
ceremonies
Ethnobotanists
record indigenous peoples’ knowledge of plants and
apply scientific methods to determine how useful and
accurate the information is
identify and determine how to protect and sustainably
harvest useful plants
aim to preserve both the plant species and the
knowledge that native people have about them for
continued benefits to humanity
Medicine and botany
Pharmacologists researching drugs were at one
time required to understand the natural plant
world, and physicians were schooled in plantderived remedies.
As modern medicine and drug research advanced,
chemically synthesized drugs replaced plants as the
source of most medicinal agents in industrialized
countries.
Research in plant sources continued and plants
were still used as the basis for some drug
development, but the dominant interest (and
resulting research funding) shifted to the
laboratory.
Drugs of natural sources
Many of today's drugs have been derived from
natural sources
ancrod
aspirin
cylcosporin
curare
digitalis
hirudin
lipirudan
morphine
quinidine
tirofiban
ACE inhibitors
Medicine for malaria
Quinine, from the dried bark of the cinchona
tree (Cinchona officinalis), has been used for
hundreds of years as a treatment for malaria.
In the 1950s, physicians noticed that patients
with malaria lost their cardiac arrhythmias
when treated with quinine bark.
A different alkaloid, quinidine, was found to
induce this effect.
Medicine and wisdom
With the incredible new biotechnology tools we now
have, we are going to find new medicines from
species we don't even have names for yet, and we
can go back and find new compounds even from
species that have been studied.
Cordyceps fungus, the source of cyclosporin, makes
transplant surgery possible.
Cordyceps fungus has been extensively studied in
terms of new compounds with potential for very
different applications, and is worth hundreds of
millions of dollars.
Drug company interests
Captopril had it's origin in snake venom.
Until it went off patent recently, captopril was
Bristol-Myers Squibb's most valuable drug —
$1.6 billion a year.
New chemicals can inspire the creation of
chemicals or semi-synthetic chemicals that can
lead to new medicines for things that can't be
cured or for which the cure has nasty side
effects.
Snake venom and ACE
Angiotensin-converting enzyme (ACE) inhibitors were
developed from a component of the venom from the
Brazilian arrowhead viper Bothrops jaracusa.
ACE converts an inactive precursor into the locally
active hormone angiotensin, which causes blood vessels
to constrict and hence raises blood pressure.
Small peptides in the venom were found to prolong the
action of the local hormone, bradykinin, which also
dilates blood vessels.
By pharmacologically blocking the activity of ACE, blood
pressure can be reduced.
The venom components block the ACE that inactivates
bradykinin and activates angiotensin's precursor.
A case of type 2 diabetes
The blood sugar level of a woman diagnosed by a
physician as having adult-onset type 2 diabetes
dropped from 536 to 136 mg/dL (29.8 to 7.5
mmol/L) after ingesting a shaman’s potion of 4
plants.
The potion was administered 3 times a day for a
week, once a month.
The physician measured her blood sugar levels after
treatment, which was clearly effective in this case.
Laboratory study of the 4 component plants showed
little or no ability to lower blood sugar in a
significant way, but the 4 plants working together
did lower blood sugar.
Bioprospecting
Profit sharing vs profiteering
Many of the large pharmaceutical companies have
programs that involve seeking out plants.
The history of this practice — rape and run — is no
longer an accepted way of doing business.
The new business model
Compensation as a standard cost of doing business.
Compensation is given not only to the natives, but
to the host government, national government, and
state government.
Compensation is also given if a product is brought
to market.
Rainforest destruction
Rainforests are the richest, oldest, most productive
and most complex ecosystems on Earth.
Rainforests cover less than 2% of the Earth's
surface.
Global rates of rainforest destruction
2.4 acres (1 hectare) per second
149 acres (60 hectares) per minute
214 000 acres (86 000 hectares) per day
78 million acres (31 million hectares) per year
Myers N. Deforestation rates in tropical forests and their climatic
implications. London UK: Friends of the Earth; 1989.
Loss of species diversity
Rainforests are home to 40%–50% of all life
forms on Earth — as many as 30 million
species of plants, animals and insects.
Species extinction
It is estimated that an average of 137 species
of life forms are driven into extinction every
day, or 50 000 each year.
Wilson EO. The diversity of life. Cambridge, MA:
Harvard University Press; 1992.
3 programs
The Amazon Conservation Team
The Ethnoecology Initiative works with indigenous
peoples of Latin America to integrate traditional
ecological knowledge and practices into local
conservation strategies.
The Indigenous Resource Conservation Initiative
facilitates international exchange of ideas, experiences,
and conservation and development alternatives among
local peoples.
The Shamans and Apprentices Program fosters
partnerships between shamans and younger tribe
members to develop the next generation of healers and
environmental guardians by honoring the past and
preparing them for the future.
The Yurayaco Declaration
The Inganos of the Columbian Amazon were on the
verge of extinction; their land had been degraded
to a large degree, if not destroyed, by western
intervention.
The youth were not interested in the old ways and
were entering the cocoa trade
In June 1999, the Amazon Conservation Team
sponsored the first-ever medicine man meeting —
42 of the most ancient and powerful Ingano
shaman from 7 tribes got together to discuss the
fate of their cultures and forests
The result was the Yurayaco Declaration; 14
resolutions the concerning the medicinal plants of
their territories and their culture
The best of both worlds
Shamanistic medicine does not have all the
answers.
Western science allows us to understand
shamanistic cultures, take the medicines out of
these cultures and put them in a format that
will work in the developed world.
The goal is to take the best of western
technology with the best of traditional
medicine, and to preserve the native culture
and ecosystem.
Pilot projects needed
www.ethnobotany.org
Pilot projects are needed to bring western
technology and traditional medicine together.
Physicians need to begin talking about the
importance of biological and cultural diversity;
environmentalists don't have the influence the
medical community has to make this happen.