1. Xki yoma’ and xki tienda - Interface between traditional and modern medicine among the Mazatecs of Oaxaca, Mexico Peter Giovannini & Michael Heinrich Centre for Pharmacognosy and Phytotherapy, The School of Pharmacy, University of London The School of Pharmacy, University of London

2. Separation between research on the use of medicinal plants and pharmaceuticals Researchers have focused separately on the use of - medicinal plants (ethnobotany) Researchers have focused separately on the use of - medicinal plants (ethnobotany) - pharmaceuticals (pharmaceutical anthropology) - pharmaceuticals (pharmaceutical anthropology) However, we need an integrated understanding of a community’s health seeking However, we need an integrated understanding of a community’s health seeking Ethnopharmacology focus on the use and knowledge of local materia medica, or ethnopharmacopoeias, Ethnopharmacology focus on the use and knowledge of local materia medica, or ethnopharmacopoeias,

3. Research questions How both traditional and modern medicine are used in an indigenous community? How both traditional and modern medicine are used in an indigenous community? To what extent these categories reflect the local uses of medicines? To what extent these categories reflect the local uses of medicines? Is this separation useful for ethnopharmacological studies? Is this separation useful for ethnopharmacological studies?

4. Field site: a Mazatec community Indigenous people living in Northeast of Oaxaca, Mexico. 70% Mazatec Monolingual Indigenous people living in Northeast of Oaxaca, Mexico. 70% Mazatec Monolingual About 400 people About 400 people  Subsistence economy  Coffee is the main source of cash  Epidemiology similar to other rural communities in developing countries

5. Cognitive distinction between medicinal plants and pharmaceuticals Xki yoma’ (our medicine) Xki yoma’ (our medicine) Xka Xki: Medicinal plants Xka Xki: Medicinal plants (self-treatment and/or tradtitional healer) (self-treatment and/or tradtitional healer) Chjota Chjine: Curandero Chjota Chjine: Curandero Xki-tienda (shop’s medicine) Xki-tienda (shop’s medicine) commercially available pharmaceuticals and supplements. commercially available pharmaceuticals and supplements. over the counter medicines over the counter medicines prescription medicines prescription medicines vitamins and supplements vitamins and supplements

6. Self-medication is usually the first therapeutic choice Treatment choice in the study site* *Informants were asked to recall sickness episodes in the last 8 days and the treatment they chose. 38 Case studies were recorded. 61% Self medication 5% No treatment 34% Self medication & Local health clinic

7. Contemporaneous use of medicinal plants and pharmaceuticals. Only pharmaceuticals Medicinal plants and pharmaceu- ticals Only medicinal plants 47% 36% 17% *Remedies used within the 38 case studies recorded Remedies for self treatment*

8. The reality: Integration of knowledge Empirical knowledge of pharmaceuticals has been integrated with previously existent empirical use of medicinal plants: Empirical knowledge of pharmaceuticals has been integrated with previously existent empirical use of medicinal plants: - Self-treatment is very common - Pharmacopoeia: Medicinal plants and pharmaceuticals - Empirical use of the remedies - Self-treatment is very common - Pharmacopoeia: Medicinal plants and pharmaceuticals - Empirical use of the remedies Adaptative usesMaladaptive uses

9. Local use of medicines is beneficial for the most common health conditions faced by Mazatecs. PharmaceuticalsMedicinal plants Assessment of efficacy based on the available literature Assessment of the efficacy of the active principle for the local use. 75% 25% Efficacious Undetermined Or not efficacious No evidence 33% 15% Same use in different cultures 13% In vitro evidence In vivo evidence 34% 5% Clinical evidence

10. Some medicines used by Mazatecs are unsafe Pharmaceuticals:Medicinal plants: Two of the most culturally important species are toxic: Aristolochia odoratissima Aristolochia pentandra 69% 17% 14% Safe Unsafe Undetermined Assessment based on active principles and whether commercialisation has been restricted or banned in other countries

11. Mazatecs consider several attributes when differentiating medicine Xki-yoma’ (Medicina de nosotros) Xki-tienda (Medicina de patente) TraditionalModern From inside From outside CheapExpensive Mild (but traditional shamans are considered the strongest) Stronger (nga-nio’) Easy access Constrained access Less contraindications (less food restrictions) More contraindications (more food restrictions)

12. The differences on medicines’ attributes influence treatment choice and favours complementarity The use of both kind of medicines extends the range of options available

13. Analysis of the use of medicinal plants and pharmaceuticals by native categories of illness Number of medicines *: at least 2 use reports for the same use

14. Conclusion In the Mazatecs case, pharmaceuticals complement the autochthonous tradition of herbal medicine The empirical use of both kind of medicines is better represented by several attributes rather than just by the contraposition between “traditional and modern”. Ethnopharmacology needs to embrace the integration of multiple forms of medicine on a local level.

15. Acknowledgements To the Mazatecs To the Mazatecs To the School of Pharmacy for a studentship To the School of Pharmacy for a studentship To Rick Cannell Travel Fund (LSoP for travel grants) To Rick Cannell Travel Fund (LSoP for travel grants) To Mexican institution: ITAO, MEXU, UNAM To Mexican institution: ITAO, MEXU, UNAM