Tuesday, February 1, 2011

Life is For Living /The Universal Antidote

BEWARE: long post below

My calls for some new adventures have not fallen on deaf ears. Things are really firing up and taking off in terms of traveling and having new experiences here in SE Asia, Borneo in particular. On Saturday I joined SBC's traditional knowledge  group (TK) for the first of three TK-oriented trips I'll be joining over the next month. I think I probably mentioned this before, but let me first expand on the role of TK in SBC's mission. This will be important for this post and for later ones, and in general is a good opportunity for me to discuss some of the issues that TK runs into while trying to achieve its aims. To combat the gradual loss of traditional knowledge in younger generations increasingly exposed to a modernized world, the TK program was established to document the various ethnobotanical practices of the many different peoples of Sarawak. Whether a plant is used for shampoo, treatment of infection, making blowpipes, or just for eating, TK travels to different kampungs (villages) all over Sarawak to learn from the communities which plants they use and how. Moreover, TK tries to help the communities better document the knowledge, while also helping to potentially let the people have better access to the plants they have uses for. In some kampungs, TK helps the community build an herbal garden containing plants most often used. By cultivating the plants, they don't necessarily need to go out into the sometimes precarious jungle to track down one of these plants growing in the wild.
       But of course there's never just a single reason for most anything. For many of these kampungs, the herbal garden also becomes a hoped source of revenue, as a guide could explain to a tourist how some of these plants are used by the community. Then the garden becomes part of a  bigger ecotourism package in the region, potentially with a jungle trail leading to attractive destinations like waterfalls, and maybe other activities. But TK's role here is just to help teach the community how they can pursue this if they truly want. At no point is the community bullied or pressured into making their kampung into a homestay or even having the herbal garden in the first place. But if they do desire, then the TK group will do their part to help get the community started.
         Back to my actual trip. Gilbert and I joined the trip to Kampung Jagoi Duyoh, a Bidayuh village near Bau (about half an hour to the South of Kuching), which is known for its past history of gold mining and its currently arsenic-rich blue lake, Tasik Biru.  The kampung is named after Mount Jagoi on which it is situated. The purpose of this trip was to get together our group with some academics, some people in Sarawak's tourism board, and of course the Bidayuh of the Kampung, for a survey of the trail they have set up, the herbal garden our TK group helped them put together, and the supposedly great view at the peak of the Mountain. This kampung actually is receiving some financing from a small grant fund, which is what helped them pay for the materials they needed to set up the garden and other components of their ecotouristic plans. I think some people working for this fund joined this visit in order to ensure something tangible had been done with the money.
        Well this trip was certainly not lacking its share of characters and great personalities. First I met Dr. Patau Rubis, a Bidayuh medical doctor who has a wide range of knowledge in both western and traditional forms of medicine. And he even said he sometimes wishes he had become a scientist instead, because of his curiosity and interest in finding the answers through experimentation. And yet, he also really bashed on western pharmaceutical companies, though with some very legitimate criticisms. He says that these companies are all so interested in identifying the one 'active' component in a plant extract. In this way they are quite narrowminded, not to consider the possibility that a mixture of compounds from the plant might be necessary for the effectiveness and safety of the therapy. And I've thought about this extensively in the past, so totally agreed with him on this one. Sure one of the compounds might kill cancer cells in your petri dish. But then when you put it into the body, maybe the stomach's enzymes (i.e monoamine oxidases) might eat the drug up, but that's why the plant already had monamine oxidase inhibitors in its tissue as well (or why the people make a mixture of different plants to constitute the full active therapy). Or maybe the 'active' chemical is so active it also is a danger to the body if not taken together with some other compound of the plant. There have been examples of both and many more cases.
         And so Dr. Rubis is quite reluctant to share many of his secret remedies, for fear that the world might misuse it and cause harm to people, but also because in the past his people and many other indigenous groups have been exploited for their knowledge and resources (not surprisingly at the hands of pharma companies in some cases). They did not receive a sen, much less an acknowledgment of their contribution. Their land was sometimes invaded and the rainforest they so revere was damaged, as the plants so important to their well being and lifeway were being ripped away from underneath their noses. This is not an exaggeration and really has happened in the past. Some aspects of these policies exist today, but there are attempts now to negotiate with communities to make sure they do receive compensation and acknowledgment (SBC actually plays a big role in this, but I'll leave that for a different post). This does not help the part about harvesting large amounts of the plants for drug development. It's why I think microbes are the answer...easy to engineer biosynthetic pathways into them, easy to optimize the production of various molecules, easy to develop facilities for growing them in large vats, and no trees chopped down in the process. I hope we can use very small, analytical samples of plants for testing and dissecting out the important biochemistry that goes on. And that these findings could be translated into microbes, to even make the combinations of drugs thought to be important for a plant extract's biomedical promise.
       But then he told us the most incredible thing. That he has this secret herbal remedy, something that only he knows about and where to find. It might be the most guarded secret they keep as a community. He claimed that this herb is a universal antidote, capable of curing any type of poison afflicting a human. He shared stories about people being bitten by venomous snakes, and how the people's arms were already paralyzed form the bite, but applying this remedy completely cured the person. And then he said the remedy is effective for addicts. The prospect of something like this stirred something inside of me. Not for the commercial potential, but for the answers it could provide us about how we process poisons, and of course the potential to improve human health.  Even how we could potentially rid people of addictions to not just illegal drugs but the most common kind (i.e. glucose!!!) which cause way more societal/health problems if you really think about it.
       There were of course some negative aspects of his sometimes blind zeal for this wonder herb. He definitely did not accept any type of potential criticism, which in the end will hurt his efforts to try to develop it into a commercial therapy. When Gilbert started to make the point that the doctor cannot be 100% sure there are no bad side effects for some people (saying that there are always exceptions, and maybe people in the West would respond differently based on somewhat different genetics/metabolism/etc) and that clinical trials are still important to conduct for the sake of ensuring the safety of the patients (not to mention the effectiveness of the drug) the doctor completely closed off. He refused to acknowledge these possibilities and said that he is the doctor here so he knows what's right.
     I do understand his disinterest in accepting that his wonder herb is anything else than miraculous and perfect, since in the past so many of these people's plant-derived remedies have been concluded to be worthless by scientists. Of course those scientists rarely put in the effort to learn about the culture and how exactly the people prepare the remedy, for if they did so they might learn that the herb is heated in a certain way, or that some components are added to the brew prior to application. Well, think about
how bad this scientific process is- if someone were to ignore a critical heating step or did not add in a reactant before preparing a chemical reaction, we (as scientists) would kind of laugh at them for making such a big error. We would be especially critical if they were then to draw conclusions about the medical potential of their product, which was achieved without the original reaction conditions previously reported to be needed for the medically active components to be produced. For some reason science has not in the past paid attention to the rituals and processes communities employ to prepare their remedies. When they have, they were able to confirm the types of reports the people originally made. And in most other cases, when they have ignored the cultural practices and then failed to find the reported bioactivity in their high throughput screens, they dropped work on the plant and immediately laid blame on the community for misinformation or ignorance.
       At the same time, I would agree with Gilbert that no one can ever rule out the potential side effects of a drug in different populations of people. By being so closed off to this very reasonable possibility (especially someone who was been trained within some framework of western medical ideas), he also gives a bit of the impression that he is no less narrow-minded than the pharmaceutical companies. Though in the end of the day, he is still acting in the interest of a noble purpose: the maintenance of his people's well being and life ways which revolve around plants like this one. I want to make the point that I'm not trying to belittle this man's very important contribution to the medical world of his community. But I do think that in the face of all the misunderstanding and miscommunication that has gone underway, it is important to present a bit of each side's perspective. Hopefully, in future negotiations and studies, we can approach these remedies with the combined wisdom of traditional practices with modern medicine.

I have a great deal of respect and belief in the work of this doctor, and ethnic healers in other communities. Sure some of these uses might be more placebo than true physiological targeting, but they are still important to the people's lifeways, including their cultural practices. And yet many of these plant uses are truly the real deal, with complex multi-target synergies that might act as true cures to conditions currently baffling the world's best scientists. There are still bountiful treasures in the world's rainforests, with potential to alleviate human suffering and truly improve the human condition, in the process teaching us new secrets about our body and mind.  In the end of the day, I am a scientist at my core. I'm so interested in how these things work on molecular targets in our body, but I'm definitely also aware of the many issues that come into play when trying to transform a traditional herbal remedy into a commercialized drug. I think we as scientists need to be more alert to the cultural and intellectual sensitivities of the people offering up their traditional medical secrets. Both for the sake of respecting these people's lifeways, and for properly investigating the nature of the practices, we need to consider the full story of the people. Or else we will miss out on some potentially marvelous new therapies. We must think much more about how to compensate the people for sharing their wisdom and resources, and how to ensure that our efforts to develop such drugs do not end up interfering with the people's lifeways, including the use of the said plants.

Ok I got a bit sidetracked, didn't I? These are some of the issues I have been grappling lately and so they're important to get out there.

So our big group went on a nice hike up the mountain (really not a difficult hike at all), while Gilbert and I found plenty of nice natural subjects to photograph along the way. I also got to speak to James Ritchie, who mentioned that he saved Ritchie (the alpha male orang utan who comes to the Semenggoh Wildlife Rehabilitation Center for feedings) from captivity. He spoke of how important is to maintain the connection to the rainforest, to appreciate it's beauty and complexity (An article he wrote about saving the Orang Utans in Sarawak: http://bridgebuilder.myfreeforum.org/archive/saving-sarawak%E2%80%99s-orang-utan__o_t__t_20.html). I also met this guy working for the Small Grant Fund, who has some serious adventuring experiences in his time. He only mentioned that in the 90s he was part of an expedition, by 4 wheel drive vehicle, from Siberia to Malaysia. On this little excursion, I really felt like I was among some of the most interesting and benevolent characters around.

The rest of the day involved us walking up to a great view at the summit of the mountain, and then coming down for some lunch served by the Kpg. Delicious Tuak (the local rice wine) was repeatedly served out of a single glass. That is, one man would go around with a shot glass and his bottle, pour a shot, watching intently to ensure the person finished and thoroughly enjoyed the drink. I must have looked as if I really enjoyed mine (and I did), because when we were ready to go back home, I was given the rest of the bottle to finish off. Again, this habit of truly enjoying another's enjoyment.

Lastly, Dr. Rubis said something on our hike that stuck with me. "Life is for Living" seems kind of trite and obvious, yet too many people don't really seem to grasp this, based on how they approach life. Dr. Rubis didn't elaborate on what he meant, but it was quite obvious to me. Simple joys like eating, drinking, walking, talking, singing, laughing are the stuff of life, making up most of what we do. It's all too easy to get wound up in our work that we forget how to enjoy life when we do have the time to do so.  Bask in the wonder that is life- the mysteries, the phenomenal serendipity that sometimes strikes our life, new experiences, new encounters, and of course the activities we often take for granted because they are so simple and require so little effort to do.

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