1. Ethnomedicine: round two David Kiefer, MD Botany 474

2. Debrief Taste –Nascent pharmacology –Bitter

3. Goals Last week –Ethno-medicine History Phytochemistry Cross-cultural –Introduced the on-line case This week –Plant identification –Cultural nuances –Immigration –Application to your “home”

4. On-line case PlantsCulture HEALTH Herbal medicine use –Madison vs home country –Why? Many factors involved Two example plant species Personal interaction with plants

5. What is hierba buena? a)“the good herb” and quite illegal in Canada and the US b)difficult to find and grow: you’ll never see it in clinical practice c)DANGEROUS. Avoid recommending it at all costs d)pretty tasty when muddled and combined with various clear liquids e)a favorite medicinal plant used by Latinos, usually for “stomach problems”

6. e) a Latino favorite  “stomach”

7. Let’s practice Each plant family has its own characteristics Lamiaceae

8. Learning plant families Latin Genus species –variety –subspecies Family –aceae (the suffix for plant families) –Asteraceae is one example

9. Effective communication Not just “echinacea” –Echinacea pallida, E. pallida var. angustifolia, E. purpurea Not just “ginseng” –Asian ginseng (Panax ginseng, Family Arialaceae) –American ginseng (Panax quinquefolius, Family Arialaceae) –Siberian ginseng (Eleutherococcus senticosus, Family Arialaceae), now called “ Eleuthero ”

10. Phytochemistry Phytochemical family trends –Alkaloids: Fabaceae, Rubiaceae, Solanaceae, Berberidaceae, Taxaceae Non-existent: Lamiaceae, Rosaceae –Saponins: Dioscoreaceae (diosgenin), Fabaceae (glycyrrhizin), Liliaceae, Agavaceae –Volatile oils: Lamiaceae, Piperaceae, Apiaceae, Pinaceae, Rutaceae

11. Culture and Health Common (20-30%) –Not born in the US –Loss with immigration Many plants –300+ species –Poly-herbacy Unknowns –Which plants –Ethnic group differences “Hispanic”, “Latino” Health care providers not trained –Adversely affects patient-provider communication –Non-disclosure Adverse plant- pharmaceutical interactions (APPI) Gardiner, 2012; Juckett, 2013; Vandebroek, 2010

12. Ceuterick et al Skim Intro and Methods –Immigration: plant use Garlic Skim Discussion –General lessons

13. Ceuterick et al. Urban ethnobotany “…migrants neither completely abandon traditional medical practices and health beliefs, nor totally reject the majority culture’s health care system…” Changes in use: Table 1

14. Table 1 Br: British supermarkets L: Latino/Colombian shops in London O: own plant at home I: import from Colombia S: send over post by relative E: minority ethnic markets in London H: health (food) stores P: pharmacy

15. Garlic Anti-helmintic –Data Augments Immune System (food, preventive) Common cold, anti-tussive Heart ailments (“good for the heart”) –Data (high blood pressure)

16. Overall 46 plants, 108 uses –153 uses in literature not mentioned in London 29 only in London –Fresh plants (wounds) left behind –No more anti-helmintics GI, common cold, heart, stress (sedatives)

17. Traditional healers Not just a “thing of the past” Belize: powerful plants from one healer were 4X more likely to be active against HIV than were plants collected randomly Snakebite: modern remedies have come from such purported cures Etkin, 2001

18. Traditional healers Plant knowledge Crucially important –Conservation –Human/ecological health

19. Hoodia Finding information: –Traditional use? Yes –PubMed: one “hit” (2002) MacLean (2004) Now: 11 articles –Review articles: nothing –Databases “Insufficient data” –Internet/Retail: overwhelming

20. Hoodia Traditional –Hoodia gordonii (Asclepiadaceae) –San: Kalahari desert abdominal cramps, hemorrhoids, TB, diabetes appetite suppressant: long walks in desert when no food is available –P57AS3 steroidal glycoside: Phytopharm, Pfizer, Unilever (Slim Fast) CNS (rats): blunts ATP decreases in with low-calorie diet –Slow-growing, limited range: CITES Rader 2007, Lee 2007, van Heerden 2007, MacLean 2004

21. Hoodia Traditional use –Possibly relevant to current use –Fill gap between retail science

22. The Herbal Team

23. Traditional knowledge

25. The Report: Section 1 Understand the scope of the project –Latinos –5 plants Kiefer’s take

26. The Report: Section 2 Garlic –Use/evidence –Adverse effects –MSN vs Ecuador –Recommend? Kiefer’s take

27. The Report: Section 3 Retail –Stock plants –Which ones? –What form? Kiefer’s take

28. The Report: Section 4 Clinics –Complicated –Ignore? Incorporate? –Tell providers? –Supply? Kiefer’s take

29. The Report: Section 5 Knowledge gaps –Next interns Kiefer’s take

30. Mrs. Jones 75 years old High BP, “bad knees”, “reflex”, atrial fibrillation Meds –Aspirin, coumadin, ibuprofen, ranitidine, hydrochlorothiazide, lisinopril, atenolol Supplements: 22 individual supplements daily…

31. Supplements Multi-vitamin B-complex 50 Calcium Magnesium Boron Fish oil caps (2 daily) L-carnitine CoQ10 Alpha-lipoic acid Licorice Slippery elm lozenges Ginkgo Ginger capsules Turmeric Hawthorn Chromium Enzymes Catechins Bilberry Thymus glandular Asian ginseng Melatonin

32. Should she be on licorice? a)Yes b)No c)Maybe

33. Summary Botanical identification (taxonomy) Cross-cultural nuances –Ecuador vs. US vs. other countries vs. your experience –Many factors involved

34. Other aspects to herbal medicine Collecting and identifying Correct names –Ex: what is mentha? Preparing the plant for an herbarium specimen

35. Collecting plants Indentification/taxonomy Field notes: notebook –Location, date, conditions, ecology, companion plants, color, taste, smell –Ethnobotanical use Draw plant, photo Focus on fertile specimens –Who has a fertile specimen? –Who has a sterile specimen?

36. Connections to “modern medicine” 18-25% of our prescriptions are plant-derived –Semi-synthetically made from plants –Still extracted (Farnsworth, 1977; Duke, 1993; Grifo, 1997)

37. We need Nature “…researchers could not have invented the anticancer compound taxol, taken from the Pacific yew tree. It is too fiendishly complex a chemical structure, says natural-products chemist Gordon Cragg, of the U.S. National Cancer Institute.” (Plotkin, 2000) “Although chemists can ring many changes on a known structure, for the foreseeable future we will still rely on Nature to supply us with new structural types for investigation.” (Huxtable, 1992)

38. stay together learn the flowers go light -Gary Snyder