The whole world needs new medicines.

We need new antibiotics because dangerous bacteria have become resistant to the ones we currently use.

We need new painkillers because too many of our existing strong analgesics are addictive, and they are not even very effective for some types of pain.

We need better treatments for mental illnesses such as anxiety, depression and insomnia that work quickly and with fewer side effects.

And although we are making progress in treating some forms of cancer, others are still without an effective treatment.

Indigenous knowledge has already given rise to many very effective pharmaceuticals. To give but three examples:

The Egyptians and Sumerians used the bark of the willow tree to relieve pain over 3,500 years ago. Western researchers concentrated and improved this herbal product. Bayer eventually developed a process to manufacture the active ingredient, salicylic acid, and market it as Aspirin. This drug is still a staple of pain control. It has developed a new role as an anticoagulant for cardiovascular disease, and it may even prevent some types of cancer.

In 1596, Sir Walter Raleigh wrote that when tribes in Guyana went hunting, they poisoned their arrows with an extract of a vine. Injection of that poison causes paralysis and death, but it is inactive orally, so the meat is safe to eat. European researchers found that the poison worked by blocking signals between nerves and muscles, causing paralysis. In 1942, Dr. Griffith, a Canadian anesthesiologist, used a purified version of the poison to produce safe muscle relaxation for abdominal surgery. Curare gave rise to a family of synthetic muscle relaxants that are essential for modern surgery and intensive care.

In 1957, Tu Youyou led a team that searched through ancient textbooks of traditional Chinese medicine to find a cure for chloroquine-resistant malaria. Her team found a reference to sweet wormwood, which had been used in China around 400 AD to treat “intermittent fevers,” a symptom of malaria. This research eventually gave rise to the discovery of Artemisinin, now one of the major anti-malarial drugs, and possibly a treatment for some types of cancer. This discovery was hailed as “arguably the most important pharmaceutical intervention in the last half-century.” Tu Youyou received a Nobel Prize. She said that “Artemisinin… is a true gift from old Chinese medicine.”

Up to 50% of the drugs developed during the last 30 years are either directly or indirectly derived from natural products. There are likely many more plants that produce chemicals that could be the basis of human medication, but where to start? The Native Plants of North America Database lists 13,345 native plants.

One obvious starting point is the ancestral knowledge of our indigenous people. Their elders have a vast knowledge of native plants and have used them as medical treatment for centuries. Undoubtedly, a systematic study of indigenous herbal medicine would uncover scores of potentially useful chemicals and result in the discovery of dozens of effective therapies.

Unfortunately, colonial powers around the world have historically tried to suppress indigenous medical practices. There is a paucity of literature on Indigenous approaches to healing within Canada specifically, and little documentation and discussion of Indigenous healing methods in general. With this, there is currently no formal Canadian (or US-based) Indigenous health policy framework or nationally adopted policy on Indigenous traditional medicine. This is a problematic area for research, as even documenting indigenous knowledge presents a risk of cultural appropriation and disrespect, as some traditions are considered sacred and not available to outsiders.

An organized and well-funded study of indigenous treatments would seem to be an opportunity for reconciliation. Settlers would acknowledge the expertise of indigenous groups. There would be employment opportunities as people documented the medicinal use of herbs and as plant specimens were collected and cultivated to allow further investigation of their healing properties. Eventually, new medicines would benefit both settler and indigenous populations in Canada and around the world. Win-win!

But a slightly deeper analysis of the situation raises awkward problems. Many indigenous cultures believe that sickness is a message from the Creator to guide them reorient their life toward the laws as established in the creation. They do not think that treatment can be reduced to swallowing a pill or injecting a pure chemical from a vial. In their cultures, medicine is about the relationship between the sick person, sacred beings and the healer.

Western medicine recognizes the importance of some of the social aspects of providing care. We value physicians who have a sympathetic “bedside manner” and we know that a placebo will often relieve a patient’s symptoms. However, in the end, the mainstay of much Western medicine is based on prescribing the correct dose of the appropriate drug on the form of pure chemical.

Many organizations recognize that indigenous people have a right to access and use their traditional medicines. The United Nations states that “Indigenous peoples have the right to their traditional medicines and to maintain their health practices, including the conservation of their vital medicinal plants, animals, and minerals. The World Trade Organization has stated that “traditional medicine contributes significantly to the health status of many communities and is increasingly used within specific communities in developed countries. However, most of the approximately 7.5 million Indigenous peoples who currently reside in Canada and the United States (US) are usually treated in Western systems of medicine.  

Over 400 plants and fungi are known to be used by indigenous Canadians, but few have been subject to clinical trials. Nevertheless, traditional remedies such as wild ginger, blue cohosh and echinacea are used as herbal medicines by settlers.  When traditional indigenous medicines are used, little benefit flows to indigenous people. A 1993 estimate put the total world sales of products derived from traditional medicines in North America as high as US$43 billion. In the early 1990s, it was estimated that “less than 0.001 per cent of profits from drugs developed from natural products and traditional knowledge accrue to the traditional people who provided technical leads for research”.

The early stages of uncovering effective medications from indigenous herbal medicines would depend on the participation and engagement of indigenous experts. However, once suitable candidate chemicals had been isolated, the work of creating pure commercial medicines would move to the laboratory, the factory, and hospitals, where few indigenous people would have the training and qualifications required to participate.

Eventually, factories would be able to manufacture synthetic versions of the active chemicals found by the investigation on an industrial scale. This would create profits that could be shared with indigenous groups, where they could be used for important initiatives to ensure access to clean drinking water, education, internet access and other essentials of modern life, but manufacturing chemicals would only create employment opportunities for a small number of skilled indigenous people. Giving people handouts based on the knowledge of their ancestors, without meaningful work, might exacerbate social problems. Equitable division of these funds between indigenous groups could be problematic and may create friction between groups that benefit and groups that do not. Perhaps a portion of the the profits from drug sales could be used to create an “Intergenerational Savings Fund” that would be managed by the tribal elders.

Despite all these issues, it would seem foolish to ignore the possibility that a study of indigenous medicines would give rise to much-needed new medications. We need to find a way that everyone can benefit from traditional knowledge without exploiting indigenous peoples

As Canadian health care professionals, we need to establish a Canadian program to develop badly needed new medicines, based on a systematic study of indigenous knowledge, in a way that respects indigenous cultures, benefiting both indigenous peoples and our patients around the world