Using Indigenous and traditional medicine knowledge in research and development for drug discovery: hypothetical case vignettes

Background Indigenous Knowledge (IK) and Traditional Knowledge (TK) have long contributed to global health through the sustainable use of medicinal plants. Yet, their integration into pharmaceutical research and development (R&D) often occurs without adequate recognition, protection or benefit sharing for the knowledge holders. This paper explores how IK and TK are used in early-stage drug discovery and reflects on the ethical, scientific and regulatory implications of their application. Methods We developed two hypothetical case vignettes to illustrate common research scenarios involving the use of IK and TK: one based on non-codified, orally transmitted knowledge shared directly by an Indigenous community; and the other based on codified historical medicinal knowledge sourced from historical botanical texts, where provenance may be unclear or obscured. These vignettes were developed using Both-Ways Collaborative Yarning and reflexive thematic analysis, informed by existing literature and expert validation. Results The vignettes highlight the strengths and limitations of current research models, particularly regarding knowledge provenance, methodological validity, community participation and benefit sharing. The non-codified case demonstrated the importance of community-led processes and contextualised preparation methods, whereas the codified case raised questions around the ethical use of archived knowledge with uncertain origins, including issues of provenance, accountability and potential misappropriation. Both cases demonstrated the efficiency and value of IK and TK in narrowing down viable drug candidates compared to conventional random screening methods. Conclusion The findings underscore the need for more inclusive and culturally safe R&D frameworks that centre Indigenous sovereignty, implement free, prior and informed consent (FPIC), integrate holistic approaches to knowledge and include culturally aligned R&D methods. By adopting a two-ways knowing approach, researchers and institutions can more ethically and effectively partner with Indigenous people and communities to advance drug discovery while respecting the integrity of their knowledge systems.