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Secrets of the Shamans

Western drug hunters are swarming over the globe looking for medicinal plants.


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No one comes to OIosega, Samoa, for a vacation. The isIand is a thin two miIes wide, with no hoteIs or restaurants. The viIIage store stocks six varieties of tinned corned beef and scant eIse. To get from the airstrip, you either waIk or make arrangements with the IocaI schooI bus driver. ItÍs cIassic Third WorId tropics: the rain comes in torrents; the shower, in trickles.

Few white foIk come to OIosega at aII. This morningÍs fIight, however, brings a motIey six-pack: Brigham Young University ethnobotanist PauI Cox, graduate student Will McClatchey, three undergraduates, and me. Cox and crew are here to look for native healers, called taulasea, who make medicine from indigenous plants. IÍm here to look for science. IÍd heard Cox give a lecture entitled ñShamans as Scientists,î in which he railed against Western science for its dismissal of native medicine as savage and crude. ñPeople equate science with technology,î heÍd said. ñTo do so is to confuse product with process. Native healers have a rigorous, sophisticated methodology.î

Ethnobotanists like Cox travel hither and yon--more yon than hither--making friends with local populations. ThatÍs why Cox is back in Samoa for the umpteenth time; Samoa has been good to him. On the island of Upolu in 1984, healers told him of a plant used to treat yellow fever. Cox sent it on to the National Cancer Institute, which isolated a powerful antiviral compound from it, named prostratin. Prostratin is now one of NCIÍs candidates for undergoing clinical trial as a possible AIDS therapy.

Were it not for CoxÍs confidence in the medical and botanical expertise of traditional healers, prostratin would not even have been considered for trial. Prostratin belongs to a group of compounds called phorbols, which are known tumor-promoters. ñI had to go into a closed session with the NCI Natural Products Branch,î says Cox, ñand say, ïLook, the Samoans have been dosing themselves with this stuff for hundreds of years. If it were causing tumors, theyÍd have picked up on it. At least test it.Í Finally they did, and it turned out actually to inhibit tumor growth.î (Cox believes that by making a tea from the plant, healers selectively extract a benign water-soluble phorbol.)

At the moment, science seems as remote a concept as room service and a hot shower. WeÍre sitting on palm mats in the home of the high talking chiefÍs family. Paul Cox, Harvard Ph.D. and Fulbright scholar, is dressed in a shocking-pink wraparound lavalava and a shell lei. He speaks in the loud, rubbery singsong of Samoan oratory. This is an arrival ceremony, and Cox is returning the welcoming rhetoric of the village chief.

ñI thank you for your gracious greeting, which is as sacred as the mating of sea turtles on the calm sea,î intones Cox, absolutely deadpan. ñYour speech has soared on the wind like the tropical bird.î His students sit with eyes downcast, partly out of respect, partly out of dread: they may be called on at any moment to practice their fledgling Samoan.

ñIndeed, the very mountains of Olosega move to listen to your beautiful words. . . . î

Though Cox admits to being something of a devotee of faÍasamoa, the Samoan way, cultural immersion is more or less a requirement for his job. Skip the ethno and you donÍt get the botany. Ethnobotanists spend months learning a cultureÍs language and customs, getting a feel for who knows what and how best to approach them. Most ethnobotanists eventually speak seven or eight languages. In Samoa, before you talk to the healers you must talk to their chiefs. Samoan chiefs are considered stewards of the land, and custom dictates that a visitor request permission to explore the rain forest. To do it right requires a mastery not only of Samoan but of Samoan ñrespect language,î a dialect of ritualized verbosity used in formal addresses and chiefly affairs. CoxÍs speech today includes a canned preamble, a smattering of Samoan proverbs, and a recitation of local genealogy. Even with this, he says, success is less a matter of academics than of personality. ñRapport is everything,î says Cox. ñYou have to be able to jettison your own culture.î While weÍre in Samoa, we do as the Samoans do. We sit cross-legged till our knees crack. We go to church, and we love corned beef.

IronicaIIy, Cox began his Samoan fieId experience not as a scientist and guardian of traditional culture but as a Mormon missionary. In 1973 he took a sabbatical from his undergraduate study of botany to complete the churchÍs mandatory two years of service. After gaining mastery of the local language and flora, as well as a deep fondness for the Samoan people, Cox decided to pursue a graduate degree in the biology of rain forests. In 1978 he returned to Samoa with his family to complete his dissertation.

CoxÍs language skills and seamless cultural etiquette are only partly responsible for the welcome and respect accorded us this afternoon. Cox is a titled man. As the result of his efforts to preserve a 30,000-acre expanse of rain forest on the island of Savaii, he was made a Samoan chief. He literally outranks the entire village.

Even so, things move slowly. Polynesia runs on coconut time: the coconut drops when the coconut is ready. To shake the tree is considered bad form. Having left the chiefÍs house, we have now spent an hour in the living room of a woman (almost all taulasea are women) who may know absolutely nothing about medicinal plants. Cox is operating on instinct-- the woman, FaÍavela, has the ñpresence and humilityî of a healer.

This is CoxÍs first attempt to find healers in this part of Samoa (the Manua Island group of American Samoa), and so far it doesnÍt look good. If the trappings of the Western world are a barometer of a traditional cultureÍs decline, we are probably too late. FaÍavela has presented Cox with a lei, but the blossoms are polyester. Beneath a square of traditional lavalava cloth is a VCR with an American videotape. FaÍavela speaks in Samoan but has picked up some English (enough, apparently, to follow the plot of The Man With the Golden Gun). Cox gives it a go anyway. ñI think you know about Samoan medicine.î

ñI know a few things.î This could be humility, or it could be truth. To find out, Cox mentions three local plants and their medicinal uses. This is known as ñleading the healerî (or, for reasons that are not entirely clear to me, ñblowing the informantî). FaÍavela recognizes only one. Cox delivers a rococo thank-you, and we make our way to the door.

Heading back, we pass an oId bIind woman sitting on a bench eating sunflower seeds. Cox stops to ask about healers. Like Lear on the heath, she shouts into a gathering wind that makes cobwebbed skeins of her loose white hair. Cox translates under his breath: ñ ïYour people make fun of the Samoan medicine. Your hospital said itÍs forbidden for us to use our medicine. There are healers here, but they are frightened to talk to you.Í î

Cox frowns. ñThey think weÍre the narcs.î

He persists. He explains that he himself has used Samoan medicine. He flatters. He cajoles. He speaks of the ethnobotanistÍs mission and the urgency of his search.

The woman considers his words. She spits out a sunflower hull. ñGo see Agalelagi.î

Agalelagi lives on the neighboring island of Ofu, connected to Olosega by a short stone bridge. We meet in the communal fale, a concrete gazebo with a pell-mell scatter of mats. Agalelagi is old, and her health appears tenuous. With a distended belly out of proportion to her reedy frame, she seems at once overweight and frail.

AgalelagiÍs daughter arrives bearing Pepsi and a package of Chocolate Chip-a-roos.

ñDemonstrate respect,î whispers Cox. ñOpen them up and eat one.î

The village chief is away, so Cox looses his introductory rhetoric on Agalelagi. Somewhere around the mating sea turtles she begins to look uncomfortable. Cox cuts to the mission statement. The sun sets. The Chip-a-roos disappear. At last he stops.

Agalelagi blinks at us. ñI donÍt know how to make any medicines.î

Agalelagi is a fofo, a massage healer. The fofo is one of four types of Samoan specialist, the others being taulasea, fofogau (bonesetter), and faÍatosaga (midwife). A fofoÍs expertise is in manipulating the toala, or ñcenter of being.î Should the toala shift from its resting place, illness is thought to result.

As we get up to leave, Agalelagi leans over and whispers to Cox. I ask him what she said. ñShe wants to know if IÍve got anything for indigestion.î

Back on Olosega, I unpack my Western biases. If healers practice sophisticated science, what are they doing massaging the toala? Does Cox really believe that quantifiable physical ailments can be traced to an off- kilter center of being?

Cox rubs his temples. Ethnobotanists, he says, withhold judgment. ñYou can either say, ïThese things are foolish,Í or you can say, ïThatÍs interesting. What do you use to treat it?Í î The point being, each culture has its own concept of illness. Rarely do indigenous disease categories correspond one-on-one to Western ones. And though indigenous healers are more likely to recognize a spiritual component to disease, this does not mean they overlook the physical. Indeed, their symptomatologies can be maddeningly specific. The Amazonian Kayap÷ tribe has a hundred different words for diarrhea. CoxÍs Samoan medical lexicon contains a term that translates ñdark stool that resembles the ink of an octopus.î But because indigenous maladies lack ready Western equivalents, Westerners--be they health professionals or itinerant journalists--tend to assume theyÍre not real.

I ask Cox if heÍs ever had his toala manipulated.

ñIÍve been told itÍs right where itÍs supposed to be.î He pats his navel. ñSomewhere under here. They say itÍs a physical entity--that it actually palpitates. ItÍs been theorized it might be the inferior vena cava.î

And how would a healer know where the vena cava is? Much the same way as someone whoÍs been to medical school: observation and dissection. ñIn Rotuma,î says CoxÍs graduate student Will McClatchey, who does fieldwork on that remote island in Fiji, ñwhen thereÍs a butchering in the village, youÍll often find an apprentice healer hanging around, watching and learning.î Cox himself knew a healer in Western Samoa who carried out detailed dissections of miscarried fetuses.

Healers also acquire a feel for anatomy through massage. (All four specialists practice massage.) ñItÍs like our medical residents on hospital rounds,î says McClatchey. ñTheyÍre always being instructed to touch and probe--to learn what a normal kidney feels like, or how a strain feels.î Using massage, Samoan midwives can detect subtle shifts in fetal position. For this reason, breech births are unheard of in traditional Samoan villages. ñI was skeptical,î recalls Cox. ñ ïCome on,Í I said to this one healer, ïit has to happen.Í She told me, ïYou donÍt understand. We massage every week. If we feel the baby isnÍt positioned properly, we rotate it in utero.Í î

The emphasis on ongoing, preventive care further muddies attempts to compare Samoan medical science with its Western counterpart. With native medicine thereÍs less focus on acute symptoms and fast-acting relief. In some ways, healers are more akin to nutritionists than internists. ñThe Samoan healers make a lot of what we loosely translate as tonics--they just say it makes you feel better, makes you healthy.î For years Cox dismissed these things. ñIÍd write it down, but I always wanted to encourage them to move on to the interesting stuff. Well, last year I was asked by one pharmaceutical company if I knew of any immunostimulators. I said, ïHow would I recognize one?Í And they said, ïWell, people might say it makes you feel better.Í î ItÍs possible these so-called tonics contain substances that boost the immune system. ñFor example,î says Cox, ñsay we isolated a component that could increase the life span of B lymphocytes, which produce antibodies. We might have something that increases the effectiveness of the immune system.î

Has Cox found such a substance? He flicks a mosquito off his elbow. ñI canÍt talk about that right now. Any other questions?î

I glance at the scrawls in the margins of my notepad: Why do Samoans like corned beef? What is the velocity of a falling coconut? Which is harder, a coconut or a skull?

ñNo, no more questions.î

Monday morning finds us at 20,000 feet, in the grimy, rattletrap belly of Samoa AirÍs finest. WeÍre going to see Epenesa, the woman Cox calls one of the greatest healers in Western Samoa. It was this woman who first told him of the antiviral properties of the Homolanthus nutans plant thatÍs now being tested by NCI as the source of prostratin.

Cox has us wait in the car while he delivers greetings and a gift, a five-pound tin of HellabyÍs corned beef. A moment later he returns, his pink-cheeked bonhomie noticeably dimmed. Epenesa died two months ago, at 83. Cox shakes his head; there was still much to learn. ñWe talk about conservation of the rain forest, but what weÍre losing even faster is this knowledge.î

EpenesaÍs daughter invites us in. Malama is a soft-spoken woman of perhaps 60. Her hair is long, her dress is simple, and she is barefoot. Take away the black nylon fanny pack and she might have sat for Gauguin.

Cox fills her in on the progress with prostratin. At the mention of Homolanthus plants, the conversation jumps track. Cox abandons his spiel and begins scribbling notes in his field book. ñShe says thereÍs a second subvariety. Only the one with the white petiole is used to treat yellow fever. All of a sudden sheÍs talking like a Ph.D. botanist.î

ñYouÍre telling me this woman said petiole?î

Cox nods. Apparently Malama was a dedicated student of her motherÍs craft. ñSheÍs using a sophisticated botanical lexicon characteristic of healers.î Earlier that day Will McClatchey had been insisting that healers on the island of Rotuma understand terms like encircling stipules, which have to do with the way a leaf attaches to a stem. He said healers have specialized terminology not only for plant anatomy but for different growth phases.

Cox decides to find out exactly how much Malama knows. He reads from Whistler: Samoan Plant Names, and asks her to say ioe or leai, yes or no, if she recognizes the plant. Of 244 species, Malama identifies 101 with medicinal uses.

Several are new to Cox. At his request, Malama brings samples from the garden, an alfresco Walgreen that covers the better part of the yard. Cox passes the plants to his students, who are sprawled on the floor arranging leaves on sheets of the local Samoa Observer newspaper and clamping them flat in wood-frame presses.

Assuming the plants make it through customs (Cox never leaves home without his USDA Permit to Import Dirt), theyÍll be forwarded to CoxÍs collaborators to be bioassayed. Besides the National Cancer Institute, Cox has arrangements with several pharmaceutical companies for a percentage of royalties if any of these medicines ever make it to the pharmacistÍs shelf. Anything with anticancer or antiviral promise is shipped to NCI. Anti- inflammatory plants go to Schering-Plough; potential immunostimulators go to Sandoz. Though a few ethnobotanists do their own screening, Cox is happy to let the big outfits handle it. ñThey come up with the targets,î he says, ñand I hand them the arrows.î

ItÍs proving to be a fruitful arrangement. Cox says his hit rate is 7 percent--that is, for every 100 plants brought back for testing, 7 will be sufficiently promising to engender further research. Among plants chosen at random, the hit rate is 1 percent.

Cox linked up with most of his collaborators at ethnobotanical conferences, at which heÍs a frequent speaker. Sometime around the mid- eighties, pharmaceutical companies began sending representatives to the meetings. Cox was pleased though somewhat agog. ñIÍve been in this field since 1978. For six years,î he says, ñI couldnÍt get a drug company to let me in the door.î

The drug baronsÍ sudden interest in medicinal plants was fueled in part by developments in laboratory technology, particularly drug screening. Originally, bioassay was done using living organisms--a mouse with cancer, for example. The plant extract was administered, then the scientists waited and watched to see what, if anything, would happen. The process was time-consuming and imprecise. These days scientists know more about the disease process, how viruses and bacteria replicate, and how these processes can be blocked. Modern molecular biology has also spawned new ways to test a plantÍs potential to intercept the distinct molecular events that occur as a disease unfolds.

With HIV, for example, the AIDS virus, researchers know that the virus attacks the bodyÍs T cells--white blood cells that are critical components of the immune system. By binding to a specific protein, called CD4, on the T cellÍs surface, the virus gains a foothold on the cell; it can then proceed to insert its own deadly packet of genetic material into the normal DNA in the T cellÍs nucleus. In theory, if this early step in the process can be prevented, the infection can be halted. So researchers are cloning the CD4 protein, then presenting it with various plant compounds in the hope of finding something that can take the virusÍs place, glomming onto the CD4 receptors itself and thus blocking the virus from ever getting a grip on the cell. Other bioassays are directed at other steps in the infection process--one, for example, searches for substances that will deactivate the enzyme HIV needs to make copies of itself.

Should a plant extract show therapeutic promise, whether for AIDS or any other disease, the researchersÍ next step is to pinpoint precisely which active ingredient is doing the trick. ThatÍs no mean feat: just one of the leaves Malama hands to Cox probably contains 500 or more different chemical compounds. Once the precise active compound or family of compounds of a particular plant extract is isolated, the researchers must determine its molecular structure, which theyÍll need if they are to synthesize the compound. Unlike the natural model, a synthetic drug may be modified to increase its effect, reduce its toxicity, or both. From there, itÍs on to the clinical trials. All told, the journey from healerÍs hand to pharmacy shelf can take a decade.

What do the native healers get from all this? Years later, will anyone even remember the taulasea who have yielded their secrets to Westerners? If one of Ma-lamaÍs plants turns out to be the next taxol, will she see a share of the profits? If Cox has his way, she will. As healers are rarely conversant in the particulars of intellectual property rights, it falls to ethnobotanists to see to it that native communities are justly compensated. No pharmaceutical born of a healerÍs lead has yet made it to market, so itÍs hard to gauge how successful theyÍll be. But one pharmaceutical company that focuses specifically on ethnobotany, Shaman Pharmaceuticals in South San Francisco, already gives a percentage of its research budget to local communities or their governments and has vowed to give a percentage of any profits as well.

Cox himself plans to donate one-third of any patent royalties he receives to the village of the healer who shared the information. His collaborators seem well-intentioned, if somewhat noncommittal. NCI, for example, has promised a ñlargeî but unspecified portion of license royalties to the native people involved (or, more likely, to their government). Sandoz and Schering are waiting for pay dirt before they talk percentages. CoxÍs hope is that theyÍll agree to donate one-half to 1 percent of gross product sales.

At the moment, Cox isnÍt interested in contracts and royalties. HeÍs scribbling full tilt. His tongue is parked at the corner of his mouth, and one lank forelock hangs in front of his eyes. McClatchey clears his throat. HeÍs been trying, so far unsuccessfully, to break into the conversation between Cox and Malama. As a pharmacist, heÍs interested in the particulars of dosage and side effects.

At last Cox sets down his pencil. McClatchey takes the opportunity to ask Malama how she prepares the antifungal plant sheÍs been describing. Cox translates: ñGather about 400 leaves, take them two at a time, and grind them up.î Unlike Asian healers, who use dried plants, Polynesian healers work mainly with fresh material, which is rubbed into the skin, ingested, or, occasionally, burned and inhaled.

I ask McClatchey if Rotuman healers are this precise in their instructions. ñTheyÍre very specific,î he says. ñTheyÍll say exactly how many leaves, what size, and whether I need to remove the stalk. Then theyÍll tell me how many coconut shells of water to dissolve it in or, if itÍs being administered as a transdermal, how much to apply and how often.

ñTheyÍre also very specific in their directions to patients. I watched a healer prescribe a medication for high blood pressure. He told the patient, ïDonÍt go swimming in the ocean, and if you start to experience mak sul mafa, then youÍve been taking too much.Í Mak sul mafa is orthostatic hypotension, or low blood pressure--itÍs what happens when you sit up quickly and feel faint. In my practice as a pharmacist, if I were dispensing high blood pressure medication, IÍd warn you about the same thing.î

How do healers know all this? Who conducts the clinical trials? Cox explains it this way: in traditional medicine, knowledge is accumulated not by one researcher but by an entire culture through time--sort of a historical bioassay. The result of centuries of clinical practice is an extensive selection process for safety and efficacy.

And who discovered these plantsÍ therapeutic effects in the first place? Moreover, how? Samoan healers like Malama simply say the knowledge was handed down from their ancestors. But someone somewhere had to figure it out. Did ancient healers go through the forest trying everything till they hit on something that worked? Probably not. ñItÍs a good deal more sophisticated than eat this, live or die, then go on to the next,î says Steven King, a vice president at Shaman Pharmaceuticals and an ethnobotanist himself. He notes that healers are keen observers of nature. ñSome of the Amazonian groups can look at any one of a hundred different trees and tell you which animals eat the fruit and which insects eat the leaves.î By taking note of who does or doesnÍt eat what, when, and how much, a healer can gauge both a plantÍs likely effects and its potential toxicity. (When scientific consultants use this sort of information to generate promising drug leads, itÍs called ñbiorationalism,î and pharmaceutical companies pay dearly for it.)

A chicken has wandered in the back door, inciting momentary apoplexy in a small brown puppy. Malama ignores this. She sits serenely in her wooden chair, a stalk of hibiscus in one hand like the scepter of a South Seas tarot queen. Above her head a potted coleus turns in the breeze. Oddly, the plant is artificial.

I ask Malama whether she tries out new plants--say, if someone comes to her with an unfamiliar illness. She shakes her head. McClatchey volunteers that other healers do occasionally experiment. On Rotuma, after comparing the symptoms of a new disease with those of diseases they know, theyÍll draw from their repertoire of some 200 plants to come up with a novel combination. Before trying something new on a patient, healers will typically test it for safety. Rotuman healers practice their own version of Phase I animal trials. ñItÍs a bit quicker than the FDA,î observes McClatchey. ñThey feed it to a dog or a pig and watch what happens.î DonÍt laugh. These animals have digestive tracts similar to ours; the FDA also tests drugs on dogs and pigs. In Central America, some healers proceed directly to human trials: they try it themselves.

In modern-day Samoa there is little call for experimentation. These days, healers often look to Western medicine for remedies. On a shelf alongside a framed photograph of MalamaÍs family is a bottle of Pepto- Bismol Maximum Strength and a container of Nyquil. I ask Malama if she uses these.

ñSometimes. When IÍm lazy to make the Samoan medicine.î

Before we go, I ask the great taulasea what she believes to be the secret to good health. She says nothing for a moment, then smiles. ñDonÍt worry, be happy.î

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