Methodological and Technological issues in Technology Transfer

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Case Study 28

Medicinal Plants vs. Pharmaceuticals for
Tropical Rural Health Care
Thomas J. Carlson,
Department of Integrative Biology,
University of California, Berkeley, CA 94720-3050

Keywords:Medicinal plants, pharmaceuticals, biodiversity, ethnolinguistic diversity, tropical countries, USA, Europe

Summary
Tropical rural communities may receive treatment from locally available traditional botanical medicines and/or modern pharmaceuticals. Assessment of these two medical systems generates interesting comparisons when evaluating local indigenous versus external control, access, availability, affordability, long term sustainability and ability to safely and effectively use each medical system. Each medical system maintains a characteristic capital flow between North and South and rural and urban. Traditional botanical medicine is based on local indigenous resources and knowledge. Climate change and ecosystem damage diminish the local biological resources available to tropical rural communities to contribute to their health care needs.

Background
While pharmaceutical companies conduct advertising campaigns in tropical countries to increase consumption of pharmaceuticals in urban areas, most people living in rural areas have limited access to or can not afford these drugs. The World Health Organisation (WHO) estimated that 80% of people in the world use medicinal plants as their primary health care medicines. Research on the bioactivity of tropical medicinal plants has demonstrated that most are safe and effective therapies. Unfortunately, tropical public health programmes do not usually recognise the therapeutic value of traditional medicine and instead encourage widespread use of pharmaceuticals to treat diseases already adequately managed by locally available traditional botanical medicines.

Due to the research, development, formulation, packaging, distribution, and refrigeration costs, pharmaceuticals are capital and energy intensive forms of medicine that are under external urban and/or Northern control resulting in capital flow from rural to urban and South to North. These capital and energy inputs make the cost of pharmaceuticals high and reduce access for tropical rural communities. If pharmaceuticals reach these communities there is often not a continuous supply or available refrigeration. If refrigeration is available it requires a high capital input and energy consumption. Many donated pharmaceuticals have exceeded their expiration date and are often for ailments that are rare or not present in the recipient communities. When pharmaceuticals are used by rural populations, they are often given inappropriately (wrong dose and/or for wrong disease) because modern medical professionals are seldom present to correctly administer these medicines.

Approach
Locally available medicinal plants can contribute to health care needs and generate economic benefits for tropical rural communities. The WHO Traditional Medicine Programme and other research programmes have conducted research on tropical medicinal plants that have demonstrated safety and efficacy for the treatment of common tropical diseases including malaria and infections of the skin, lungs, and gastrointestinal tract.

Collaborative agreements may be established that enable tropical rural communities to harvest botanical medicines from their local ecosystems and sell them to northern or tropical urban areas as herbal medicines or for the extraction of pharmaceuticals. Twenty five per cent of modern medical drug prescriptions written in the United States are pharmaceuticals derived from plant species. In compliance with the Convention on Biological Diversity, these collaborative relationships between rural communities and research institutions can include agreements that will entitle communities to receive long term benefits if marketable pharmaceuticals or herbal medicines are derived from their botanical resources.

Impacts (Achieved Benefits)
Tropical rural traditional medicines under local indigenous control are more affordable, available, and sustainable forms of medicine because they do not require the capital and energy inputs needed for pharmaceuticals. These botanical medicines are typically more therapeutic and safe because the medicine source is locally harvested and knowledge of its medicinal use is known by the local ethnolinguistic group. Use of ethnobotanical knowledge can also generate economic benefits that result in capital flow from urban to rural and North to South enabling local communities to use these resources to establish land demarcation, community-based medicinal plant reserves, traditional medicine hospitals, infrastructure support for a traditional healers' union, supplies for schools, and clean water systems. These health care and economic benefits derived from ethnobotanical knowledge generate incentives for tropical rural communities to conserve their biological and ethnolinguistic diversity.
Lessons Learned

First, as demonstrated in Table 16.1, many barriers exist to safe, effective, affordable, and sustainable use of modern medicines in tropical rural communities. Tropical botanical medicines under local rural indigenous control are more affordable, available, therapeutically beneficial, and sustainable for these communities.

Second, modern medical health care programmes should work to complement rather than replace the local traditional botanical medical systems. The use of modern pharmaceuticals at the local rural level should be reserved to only treat those diseases not well managed by the local botanical medicines. When pharmaceuticals are used for specific ailments, there should be careful monitoring of the treatment by modern medical professionals to make sure the correct dose is given and the appropriate disease is being treated.

Third, the local traditional medical systems should be included as integral components of tropical health care programmes.

Fourth, use of ethnobotanical knowledge and harvesting of non-timber medicinal plant products from their local ecosystems can generate economic benefits for rural communities.

Fifth, the health and economic benefits of botanical medicines can establish incentives for rural tropical peoples to conserve their ecosystems, ethnobotanical knowledge, and languages.

Sixth, and perhaps most relevant to the climate change issue, all of these efforts to encourage the use of indigenous, ethnobotanical and local resources can help to preserve these areas, and thereby contribute to the mitigation of climate change.

Bibliography
Carlson, T. J., R. Cooper, S.R. King, and E.J. Rozhon, 1997: Modern Science and Traditional Healing. Royal Society of Chemistry, Special Publication 200 (Phytochemical Diversity), 84-95.
Farnsworth, N.R., O. Akerele, A.S.Bingel, D.D. Soejarto, Diaja, and Zhengang Guo, 1985. Medicinal Plants in Therapy. Bulletin of the World Health Organization, 63 (6), 965-81.
WHO, 1992: The Use of Essential Drugs: Model List of Essential Drugs: Fifth Report of the WHO Expert Committee, 1992. World Health Organization Technical Report Series, 825, 1-75.