Research Profile - Learning from the Elders
Dr. Pierre Selim Haddad
Photo by Marc Robitaille
Working with Cree healers has shown a team of diabetes researchers how modern medicine can benefit from age-old knowledge
Most people think of medicine as something that comes out of a plastic container with a tamper-resistant top.
We overlook the fact that the source of the medicine often is a plant, according to Dr. Pierre Selim Haddad, a pharmacology professor at the Université de Montréal's Faculty of Medicine.
"People tend to forget that," says Dr. Haddad, who has spent the past six years working closely with the Cree of Eeyou Istchee in Northern Quebec to study the antidiabetic properties of their traditional plant-based therapies. "Studies suggest that 40% to 60% of the most prescribed drugs worldwide are derived from plants."
At a Glance
Who – Dr. Pierre Selim Haddad, Université de Montréal. Leader of the CIHR Team in Aboriginal Antidiabetic Medicines.
Issue –Type II diabetes is having devastating effects on Aboriginal populations across Canada. Western approaches to treating diabetes through medicine and lifestyle changes have been less than successful because they don’t fit with Aboriginal culture.
Approach – Dr. Haddad leads a multidisciplinary team of scientists at Université de Montréal, McGill University and the University of Ottawa that is working with the Cree of Eeyou Istchee in Northern Quebec to evaluate the antidiabetic activity of medicinal plants used by traditional healers.
Impact – The goal is to develop natural health products that combine traditional knowledge and modern science and are culturally adapted to meet the needs and beliefs of Aboriginal populations.
Funded by the Canadian Institutes of Health Research (CIHR), Dr. Haddad leads a multidisciplinary team of experts from seven labs at three universities that is working directly with members of the Cree Board of Health and Social Services of James Bay and the Cree Nations of Mistissini, Whapmagoostui, Nemaska and Waskaganish.
Aboriginal people have some of the highest rates of diabetes in Canada – at least three times the rate of the general population according to the Public Health Agency of Canada. However Western style medicine and the encouragement of lifestyle changes have not been successful in combating the disease. Dr. Haddad's team is working to create culturally relevant treatment approaches that combine Western and traditional therapies for Aboriginal populations.
Based on information from interviews with Cree elders, the team analyzed 17 plants and found that nine have properties similar to the conventional drug Metformin, which is commonly used to lower blood sugar levels. That's not surprising, says Dr. Haddad, given that Metformin is a chemical derivative of a compound present in the French lilac plant. The Cree healers simply have used other plants that share similar properties, yet exhibit other equally powerful and potentially useful activities against diabetes.
"We're talking about the same thing, but just looking at it from different world views and speaking different languages. The Cree get their inspiration from contact with nature, but the end result is the same."
A case of good timing
Kathleen Wootton, Deputy Chief of the Cree Nation of Mistissini, says that working with Dr. Haddad’s team was a case of good timing and synergy. Members of her community wanted to look into ways of integrating traditional healing with Western medicine. About the same time, Dr. Haddad began inquiring about investigating the antidiabetic qualities of the plants the Elders used in their treatments.
“Somehow the universe figures out that these people should get together,” says Deputy Chief Wootton. “We had a common reason to want to look at how traditional medicines could help our people who were suffering from diabetes.”
She says the project has been a success because of the commitment the Cree secured at the outset: “We were concerned about what could happen to the traditional knowledge and the intellectual property of the Cree Elders. We wanted to make sure we had our people’s interests protected and respected. It has worked out really well – we have a really good research agreement.”
So far, the team has published more than 15 peer-reviewed papers or reports. Translating traditional knowledge to the Western world, however, is not as straightforward as analyzing the properties of the Cree medicines – extracts from plant leaves, roots and pine cones that are administered as teas, brews and balms – and going public with the results. Committed to protecting the Cree intellectual property, the researchers consult the Elders and obtain official approval before each publication.
"They want to participate in the interpretation of this research. When we set up the project, we created a steering committee with Elders, community and Cree Health Board representatives on it," says Dr. Haddad. "We have twice-a-year scientific meetings where all the labs update each other on the science and the Elders are provided with lay language summaries translated into Cree."
The team also integrates Aboriginal values into their research when they conduct clinical trials. For example, while the original plan called for randomized control trials – in which a control group gets a placebo – the idea was discarded when the Elders said no.
"For them a placebo is a fake drug, so it's unethical. We came up with a proposal to achieve similar outcomes, but with a novel composition. The final result is a very open-access clinical trial, because it's important for the Cree that everyone who wants to participate in the study can do so."
The Study
Dr. Haddad's team is currently conducting observational clinical trials to study the antidiabetic potential of traditional Cree medicines in Mistissini, one of four Northern Quebec Cree communities involved in the research the team has undertaken since 2003.
"The treatment itself is in the hands of the healer," explains Dr. Haddad. "The people meet with both their physician and their healer and it's the healer who prepares the treatment – or teaches the patient to prepare it for themselves and how to use it. The physicians and nurses then follow the patient on a monthly basis, doing a full battery of lab tests."
The 30-plus participants will be followed for four months, with an optional follow-up of another four months. The work is co-ordinated by the Cree Nation of Mistissini with help from the Cree Health Board.
"This is in the full control of the communities," says Dr. Haddad. "They are steering the clinical studies. We have clinical scientists, who make sure the clinical side of the studies meet the highest standard. But it's a minimum-intervention approach."
While he is hesitant to provide the names of specific plants or describe specific therapies, Dr. Haddad has been impressed by the results he has seen from some of the therapies the Elders have demonstrated.
"One of the most striking ones is a plant preparation that really helps with foot sores, a common complication with diabetes. People who are slated for amputation sometimes come back three weeks later and they are almost healed. This is through some powerful plants."
For more information about the CIHR Team in Aboriginal Antidiabetic Medicines, visit their website.
"When I started working with the Cree I saw myself as a 'validator' – someone from the rigorous scientific world who could authenticate the medicinal properties of traditional treatments. Now I see myself much more as a knowledge translator, providing information from traditional medicine in a language that scientists and health professionals can understand."
-- Dr. Pierre Haddad