The world is becoming increasingly aware of the importance of exploring the biodiversity of rainforests and of preserving traditional medical knowledge for developing new drugs

Heinrich, M

Zaman, N

UCL Discovery

Biodiversity uncoveredThe world is becoming increasingly aware of the importanceof exploring the biodiversity of rainforests and of preservingtraditional medical knowledge for developing new drugs.Nuruz Zaman and Michael Heinrich explainAccording to the WorldHealth Organization, for75-90% of the rural popu-lations of the world, thelocal herbalist and othertraditional healers are the only sourceof medical care.w1 This translates intothree billion people for whom medicalcare consists of wild harvestedmedicines provided by local traditionalhealers.Even considering these facts as aneye opener, what’s possibly morestartling is that many of the drugs thatclinical medicine is so familiar withwere in fact discovered from the herbalremedies of those indigenous peopleacross the world. Well establisheddrugs, such as aspirin, codeine, and qui-nine, were all developed from plantsused medicinally for centuries byvarious civilisations.Of the approximately 265 000flowering species of plants on theplanet, less than 1% have been studiedin any detail to the point of understand-ing their composition and medicinalvalue.w2 About half of all plant biodiver-sity exists in primary rainforests, likethe Amazon. But with deforestationand the rapid cultural and linguisticchanges happening around the world,we are not only losing the vastresources of the forests but also theknowledge of the indigenous people.This is a catastrophic destruction,similar to the burning of the greatlibraries of Alexandria or Baghdad, inhistoric terms.The pharmaceutical industry must,therefore, be able to work effectivelywith local people to present an alterna-tive sustainable economic model toenrich our technological medicine andalso to preserve the historical knowl-edge and the wealth of the rainforestsin the long term.w3The interest in ethnopharmaco-logical research has had a chequeredhistory. Large drug companies had aconsiderable interest in it during the1990s but moved to other groups ofcompounds in the first years of the newmillennium. Recently, a renewed inter-est in natural products and theirsources has become apparent.w4 As wellas from technological improvements,modern laboratory techniques, andenhanced understanding of pharma-cological targets,w5 the impetus hascome from the continual deforestation.Recent studies and publications aboutethnopharmacology have stimulatedmany lines of interdisciplinaryresearch.w5 w6A key factor in the long termsuccessful relationship between tradi-tional cultures and global drug compa-nies involves the protection of intellec-tual property rights, and, in particular,the group’s traditional knowledge, toprevent the threat of exploitation andto protect the interests of the healersand their communities. Increasingdemands are apparent amongresearchers within indigenous cul-tures.w8 w9 In the development of thecandidate drug prostratin, the NationalCancer Institute and Brigham YoungUniversity have guaranteed that, in caseof a successful development, a consid-erable proportion of any royaltiesearned by the drug would be returnedto the Somoan people who are the tra-ditional keepers of this knowledge. Tomany cultures, protecting the forestsaround them is at least as important asthe future potential of receiving anymoney, however.w2An example of biodiversity drivendrug discovery activities is provided bythe US company Merck Sharp andDome, which, for many decades, suc-cessfully used natural products in itssearch for new drug leads (potentiallyactive biochemicals). The company dis-continued all its direct natural productresearch in 2001, however. As for otherpharmaceutical companies, the struc-tural diversity of natural products hasbeen considered an important advan-tage. On the other hand, research onnatural products is slower (and there-fore more costly) and there is always therisk of not being able to get enoughmaterial for resupplying the drugdiscovery pipeline with larger amountsof the original material. In the early1990s, Merck Sharp and Dome linkedup with Costa Rica’s National Instituteof Biodiversity and started a systematicsearch for now drug leads from therainforest.w11The project was established in1989 in Santo Domingo, Costa Rica.Importantly, some 4% of the world’sterrestrial plant species can be foundin this 51 000 km2 territory. Part of thisproject involves the governmentallocating a quarter of Costa RicanTerritory over two decades to anintegrated system of protected andprivately conserved wild lands. Theproject also pioneered the use of para-taxonomists, local people with suffi-cient training to differentiate betweenspecies, to combat the shortage ofactual taxonomists. The institute hassuccessfully invested in local peopleand enriched the country’s biodiversityinventory. A groundbreaking collabora-tion with Merck lead to an investmentof $1m (£550 000; €820 000) into theproject.w11 Currently, the institute con-tinues to establish smaller collaborativeagreements with academic and privateinstitutions in North America andEurope. With the renewed interest insuch approaches, new drug leads fromthe rainforest are again entering thedrug development pipeline.The development of the UnitedNations’ Convention on Biodiversity, apact between world governmentsagreeing to commit to the environ-ment and ecology in the face ofeconomic development, has had aconsiderable impact on drug discoveryfrom natural products. The conventionidentifies natural genetic resources aspart of the heritage of the countries inwhich they are found and the tradi-tional knowledge about plants to beacknowledged as the intellectual prop-erty of its holders. This means thatinformed consent is required from thestewards of the genetic resources—thatis, the traditional healers, for commer-cial development. The benefits of theresearch and development as well asthe financial rewards must be shared.The Fogarty International Center ofthe US National Institutes of Healthhas developed a programme foruniversities and businesses in devel-oped countries to partner with institu-tions or groups in developing coun-tries to successfully implement theconvention. This effort is recognised asthe International Cooperative Biodi-versity Group programme, with thegoals being the discovery of newpharmaceuticals and agriculturalchemicals, scientific and economicdevelopment, and conservation ofbiodiversity.w12Nuruz Zaman final year medical student, Bartsand the London, Queen Mary’s School of Medicineand Dentistry, Queen Mary, University of LondonN.Zaman.98@cantab.netMichael Heinrich professor, Centre forPharmacognosy and Phytotherapy, The School ofPharmacy, University of London, LondonWC1N 1AXWe are notonly losing thevast resourcesof the forestsbut also theknowledge ofthe indigenouspeopleReferences w1-w12 areon studentbmj.com.editorial354 STUDENTBMJ | VOLUME 13 | OCTOBER 2005 |Foundation programme fornewly qualified doctorsRichard Hays thinks that the new UK foundation courseshould improve specialist training but may lack capacityBorn of necessity, devel-oped with remarkableconsensus, and pilotedsuccessfully for a year, theUnited Kingdom’s newfoundation programme for medicalgraduates has been launched.w1 Theprogramme aims to ensure that allentrants to formal postgraduate spe-cialist training have met the standardsrequired to progress to that particularphase of lifelong learning.w2 Opinionsvary about the role of these reformsand their impact on the medical educa-tion system and workforce.The programme focuses on per-formance in the workplace, ratherthan only knowledge and skills, largelyin response to recent scandals thathighlighted problems with clinicalgovernance, professional teamwork,and practitioners’ honesty. The corecompetencies required to complete theprogramme match those laid down bythe General Medical Council in GoodMedical Practice and reflect reasonableexpectations of the ability of juniormedical practitioners.w3 Although theUK may be the first to formalise such asystem, similar moves are being dis-cussed in other places with similarsystems of medical education andcareer progress.The introduction of such pro-grammes should not imply that medi-cal schools are not doing their job.Medical education is a long process. Injust four, five, or six years, medicalschools are expected to cover the basicelements required for competent prac-tice as a junior medical officer. Thefoundation programme is meant toensure that these competences can beapplied under supervision in the work-place. Learners learn more effectivelywhen they are responsible for theiractions, and it has always been the earlyhospital years that allowed graduates todevelop the confidence to becomecompetent practitioners. The weaknessof the previous system has been thelack of time, resources, and expertisenecessary to ensure that every juniorhospital doctor reaches that point.The new system aims to make everyclinical experience a relevant, morestandardised, better supported, andeducationally valuable experience withspecific and achievable learning objec-tives. Assessment will focus on practicalaspects of medical work rather thanexaminations, and it will reward greaterengagement by learners. The pro-gramme also brings new learningopportunities—such as posts in publichealth, primary care, and academia—where junior doctors can sample abroader range of options for hospital aswell as non-hospital careers.And the complete package includesbridges and shorter pathways to moreadvanced specialist training, removing atleast some repetition of less valuablelearning experiences, and recognisingthe more relevant and valuable place-ments that contribute to the achievementof specific career objectives. In summary,the foundation programme has thepotential to provide a sound platform onwhich to build future medical careersmore quickly and more flexibly.w4 Asusual, however, it is the implementationof these reforms that raises the mostquestions. Although the programme hasenormous potential for success, thestakes are high, and failure may not beforgiven. One response to the globalshortage of medical workforces has beena rapid expansion of undergraduatemedical education into new secondaryand primary care facilities, where serviceloads are high and educational resourcesare stretched.w5 This means that thefoundation programme will be compet-ing for learning opportunities withmedical schools and even with specialtytraining programmes, and capacity maynot be sufficient for all levels ofeducation to expand quickly.What will students and new doctorsmake of these reforms? Junior doctorsmight now be treated more likestudents, rather than junior profession-als who are adult learners. Current stu-dents are reasonably concerned thatthere may be insufficient posts, dilutedclinical experience, and the possibilitythat some may not achieve the requiredcompetences and be stranded withouta traditional career.w6 w7 And, althoughthere are advantages to identifyinggraduates who are unsuited to clinicalcareers at an early stage, will reasonablealternatives be available?The likely success of the programmein moving medical graduates to a widerrange of specialties, including thosewhere the need is greatest, is hard tojudge. Workforce trends are difficult topredict. The recent international down-turn in demand for primary care and themore general specialties may not recov-er,w8 w9 trends towards subspecialisationin primary and tertiary care maycontinue, and new specialties will con-tinue to emerge. Much of the pro-gramme’s success in directing careersmay depend on whether, and to whatextent, learners have inspirational expe-riences in such areas of need, and on thetension created by pressure to ensurethat core competencies are also achievedin more mainstream areas of medicine.Furthermore, high quality teachingand learning do not happen byaccident: a curriculum is initially nomore than a document. Medicalschools must engage with the founda-tion programme, helping to developexpertise in medical education andensuring that the years spent as juniorhospital doctors are part of a smoothtransition for graduates. There will haveto be rapid expansion in the number ofmedical graduates who have beentaught to teach—those with formaltraining in methods of teaching andlearning. Postgraduate training inmedical education may have to becomea formal requirement for at least someclinicians in each teaching facility, andmedical education may develop into aformal postgraduate medical specialty.Lastly, the current difficult pathways formedical practitioners to gain formaleducational qualifications may need tobe simplified, with more flexible profes-sional doctorates or membershipcourses. The success of the foundationprogramme, then, will require genuineacademic development and supportthroughout the entire healthcaresystem, rather than in a relativelysmall number of elite teaching facilities.Richard Hays professor of medical education,School of Medicine, James Cook University,Queensland 4811, Australiarichard.hays@jcu.edu.auCompeting interests: None declared.Do you want to be treated more like a student, rather than ajunior professional?JOHNCOLE/SPLReferences w1-w9 areon studentbmj.com.editorialstudentbmj.com 355

Biodiversity uncovered

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