Elaine Elisabetsky, Ph. D.

Written by:

Elaine Elisabetsky, Ph.D.

After finishing my PhD in the memory field, I was troubled with the prospect of my career. Although memory neuroscience is a fascinating topic from a scientific perspective, for the young demographic of 1980s Brazil, memory issues were not a high priority in public health, and I aspired for my studies to have practical implications. As a pharmacologist, though I knew that teaching and mentoring could be very gratifying, part of me envied the professional activities that, though perhaps less intellectually challenging, result in more immediate and concrete outcomes. Two pieces of information helped me respect the desire to change course: (i) I became aware that Brazil imported 78% of the medication it needed, and (ii) I learned that during the Falkland War between Argentina and the UK, the UK and allied countries ceased the export of antibiotics to Argentina. It dawned on me how the dependency in medical resources could undermine a country’s sovereignty in different ways.

During my weekly time with Current Contents (if you are old enough to be anywhere near science at that time you know what I am talking about) I came across the Journal of Ethnopharmacology. If you are not acquainted with the discipline, it focusses on investigating traditional systems of medicine. It can be used for anything from an anthropological view of an ethic group concepts of health and disease, to adapt public health info in a culturally appropriate way to ameliorate outcomes (hygiene practices, vaccines, etc), to the search for new drugs from natural resources used with medical purposes. I decided to become an ethnopharmacologist, let go of a post doc grant from the French Government to work at the Hôpital Sainte-Anne (where chlorpromazine was discovered) and Gif Sur Ivette, and move to the Brazilian Amazon with a research grant from the Brazilian CNPq (National Council of Scientific and Technological Development). At the time there was a governmental effort to take young (and unemployed) PhDs to the Amazon region. My naïve idealistic idea was that a country with one of the planet’s highest rates of biodiversity and rich in traditional peoples who know the value of the flora, that is rich in sociobiodiversity, a sound scientific effort based upon these resources had the potential to help create a national pharmaceutical industry.

Please believe me, as someone born and raised in the cosmopolitan metropolis of São Paulo — which makes me feel comfortable in NYC — an Amazonian town in the early '80s felt as foreign to me as it would to most people reading this. My strategy was to talk to as many people as possible about diseases and cures in hope to identify local treatments to mental disorders. As maintaining the health of the family members is traditionally a women’s role, I visited as many different villages as possible and baked farina, assisted in the fields, drunk midafternoon coffee, washed clothing and did whatsoever activities women do to discuss disease and treatments. Many of these activities are communal at the very small villages by the rivers or entrenched in the jungle. With my training on psychopharmacology and behavioral animal models, whenever I thought I had a decent working hypothesis, “does the species X have psychopharmacology property Y?”, I could format the experiments and test it in the lab. The other common strategy was to go to the Ver-o-Peso market, where a whole section was and is dedicated to medicinal plants commerce and learn from the vendors and their exchange with their clients.

Aa a more universal academic characteristic, you may identify when I say I needed to generate results, present posters at meeting and publish papers as any other young scientist do to hopefully establish a research group. You can then understand I could not opt/specialize in a given disorder: if what I heard led me to anxiety, or pain, or epilepsy, or depression, so be it. During the following years we were able to characterize the psychopharmacology profile and mechanisms of action of anticonvulsants (https://pubmed.ncbi.nlm.nih.gov/?term=Elisabetsky+and+Linalool&sort=date), analgesics (https://pubmed.ncbi.nlm.nih.gov/?term=Elisabetsky+and++psychotria&sort=date), a nootropic neuroprotector
(https://pubmed.ncbi.nlm.nih.gov/?term=Elisabetsky+and+Ptychopetalum&sort=date) and an antipsychotic
(https://pubmed.ncbi.nlm.nih.gov/?term=Elisabetsky+and+alstonine&sort=date) drug.

It was this last piece of research that got me into the sad and fascinating schizophrenia field. The study of alstonine as an innovative antipsychotic came from an ethnopharmacology expedition among the Igbo in Nigeria. In the early 90s, the Igbos comprised an over 10 million people tribe, organized as dozens of small kingdoms. I was part of an ethnopharmacology expedition sponsored by an American pharmaceutical company interested in antiviral drugs. During the expedition in rural Nigeria (Enugo State), we came across a group of people extracting palm oil; one in this group happened to be the King of that kingdom. After understanding what we were doing, he insisted we should visit Dr. Chidi Osondu, according to him a famous healer with clients coming from all over Nigeria. So we did and it turned out that Dr. Osondu was a traditional psychiatrist. Part of his clinic was a very dramatic sector where voodoo dolls, remains of hanged animals, a portrait of the holy supper, another from Shiva, and several other quite weird components, to say the least, were present. But in the middle of this film-like setting, his description of the treatment given to patients made every sense to me: he did X when they arrive too agitated or aggressive, or Y if not, the way he titrated the dose over the course of treatment, etc. Of note, the patients headquarter was adequate, and internees quickly rose from the floor straw mattresses (no impaired blood pressure as you would expect from a Rauwolfia extract) and politely interacted with us visitors (unlike what you would expect from patients treated with older antipsychotics). Mind you that this is 1993 and clozapine was quite new, expensive and certainly not available at rural Nigeria clinics. I was given some of the medicinal plant powder by Dr. Osondu, and with the help of chemists and my students proceeded to characterize the alkaloid alstonine as an atypical antipsychotic with an innovative mechanism of action (at the time the only that had no direct interactions with dopamine D2 receptors).
We know the prevalence statistics for schizophrenia. We also know of the difficulties in diagnosing and categorizing a disorder with such diverse presentations and courses. I have no means to know if Dr. Osondu’s patients were affected with schizophrenia, but they were certainly mentally ill enough to be admitted to the clinic for a certain amount of time. Now we are also certain that these patients were treated with an atypical antipsychotic. Our ongoing efforts aim to bring alstonine to clinical application, offering hope for improved therapeutic options and a better quality of life for individuals battling schizophrenia, as so many are underserved by current treatments. The history of alstonine makes one wonder how many useful drugs are overlooked due to Western science's inability to view other medical systems as legitimate systems rather than mere folklore. If we surpass the prejudice, a new path to discovering drugs useful for managing schizophrenia might open up.