By Peter Reuter, MD, PHD
For most of human history herbal medicines were the number one remedy used by people worldwide. All that gradually changed with the advent of chemistry and pharmacology. Instead of using herbal teas or pastes people started to use standardized drugs produced by pharmaceutical companies, prescribed by medical professionals, and dispensed by pharmacies. Many of these drugs were naturally occurring substances or derivates that had been used as part of herbal medicines for a long time. Aspirin or acetylsalicylic acid (ASA), for example, is a derivative of salicylate, which can be found in such plants as willow tree and myrtle. It was first mentioned as a remedy for pain, fever, and inflammation in an Egyptian papyrus more than 3500 years ago.
Scientists, especially ethnobotanists, went all over the planet in search of other substances from plants, fungi, and lichen that could be tested for their medicinal properties. Over time, however, chemists took over, and more and more pharmaceuticals were created in the lab. That made the process more controlled and made it easier for companies to claim patents on newly synthesized drugs. Yet, approximately 95% of tested components fail in clinical trials and for those few that pass the whole process from start to finish takes about 12 years and costs up to $800 million or more.
That kind of investment is significant for developed countries, but almost too much money for most developing countries, which explains why there are no new drugs coming out of developing countries. It also explains why there are only few and often no recently introduced drugs for rare disorders or disorders that mainly occur in poorer countries. Malaria is a typical example for that. Although there are an estimated 200 million cases of malaria every year and about half a million deaths related to malaria, there hasn’t been a new drug to treat malaria since artemisinin-based combination therapy (ACT) was introduced in the 1990s. One of the reasons for companies not investing into the development of new antimalarial drugs is that about 85% of all cases occur in Africa, where people can only afford to get the drug if governments or international non-governmental organizations (NGOs) subsidize the costs of treatment.
Starting in the mid 1990s, a new approach developed that looked into traditional herbal medicines and their efficacy in treating certain diseases. For example, researchers in India conducted a nationwide survey of Ayurvedic physicians to take inventory of herbs used to treat conditions such as arthritis, diabetes, and hepatitis. After they had identified certain herbs for treatment of arthritis they started observational studies in a clinical setting as well as animal studies. Because this approach reverses the order in which traditional pharmacology works, it is usually called reverse pharmacology.
In the case of malaria, reverse pharmacology pointed to the benefits of Mexican prickly poppy (Argemone Mexicana) for the treatment of milder cases of malaria. Although the poppy was native to Mexico, it somehow made its way to Africa sometime in the 1800s and soon became a part of herbal remedies. When researchers talked to traditional healers in Mali in West Africa they learned about the beneficial effect of Argemone tea on patients with mild malaria. That led to a first prospective study that compared using Argemone tea for half of the patients and a standard artemisinin-based combination therapy (ACT) for the other half. Surprisingly Argemone tea did almost as well as ACT therapy in patients with non-life threatening malaria, although it hadn’t been refined and patients just drank as much tea as they liked.
But, there are still a lot of scientists, especially in pharmacology, that are skeptical or outright opposed to this approach. They prefer to use well-defined compounds and point to the fact that herbal remedies often contain a mix of many active substances that may cancel each other out or cause uncontrollable side effects. Teas and infusions are almost impossible to standardize, which makes it difficult to give exact doses of active ingredients to the patients. They also point to unknown toxicities of plants or parts of plants. When we look at Mexican poppy, for example, then we find that the poppy seeds contain the poison sanguinarine, which was implicated in a mass poisoning of 3000 people in India in 1998 that lead to the death of 65 people. The leaves, however, are nonpoisonous and its tea is safe to consume.
Another success story for reverse pharmacology and herbal remedies is happening in the western Pacific. Palau is an island nation of more than 500 islands that is a paradise for scuba diving and snorkeling. However, Palau also has the seventh highest obesity rate on the planet and many inhabitants suffer from high blood pressure (hypertension) and diabetes. Instead of relying on the tried-and-true methods that failed to stop the obesity epidemic in western developed countries, doctors tried to find herbal remedies to help treat hypertension and diabetes. After analyzing traditional herbal medicines, they were able to draw up a list of herbs that showed potential. In the end two plants, Morinda citrifolica (a tree from the coffee family), and Phaleria nisidai, were associated with weight loss (M. citrifolica) and lowering of high blood pressure (P. nisidai).
Finding scientific proof that traditional herbal remedies are almost as good for the treatment of a variety of diseases as modern drugs while often having far fewer side effects is a boost to many who look for a more holistic approach to medicine. Many people in developed and developing countries are trying to live a more healthy life by eating local and often organic produce, by cutting down on animal protein, and by using traditional remedies when possible and available. The more their number grows, the more companies will try to cater to their needs and demands, and the more herbal remedies will be used to treat physical and mental health disorders.
© Peter Reuter 2015
Malaria video: https://www.youtube.com/watch?v=jayoAFAtGQY
Ayurvedic medicine video: https://www.youtube.com/watch?v=sDtIs8p0Uuc
Herbal Remedies Making a Comeback - Definitions
Pharmacology: The study of chemical and biological substances, their effects on living systems and their use to influence biological systems.
Derivative: In chemistry a substance that is based on or derived from another substance.
Aspirin: Also known as acetylsalicylic acid. A pain killer (analgesic) based on salicylic acid, which is found in the bark of willow trees. The bark has been used for at least 2500 years to treat pain, fever, and inflammation. The chemical compound was first created by German chemists in the mid-1800s and sold under the name aspirin by the pharmaceutical company Bayer starting in 1897. It is nowadays used to treat pain, fever, inflammatory diseases (e.g., rheumatic arthritis), and to prevent heart attacks and some forms of cancer.
Willow tree: Name for a subfamily of deciduous trees and shrub found in cold and temperate regions on the northern hemisphere. The bark of willow trees has been used for at least 2500 years to treat pain, fever, and inflammation
Artemisinin: A drug against malaria isolated from sweet wormwood (Artemisia annua). Artemisinin and its related substances are the most commonly used drug against uncomplicated cases of malaria caused by Plasmodium falciparum.
Arthritis: Inflammation of one or more joints leading to pain, swelling and stiffness. Acute forms of arthritis are usually caused by bacteria. Common chronic forms are osteoarthritis (wear-and-tear arthritis often caused by overloading the joint and overweight) and rheumatoid arthritis (an autoimmune disease in which the body attacks its own joints). The treatment depends on the underlying cause of the inflammation.
Diabetes: Also known as diabetes mellitus. Generic term for a group of diseases with abnormally high levels of glucose in the blood. In type 1 diabetes (10% of cases) the body doesn’t produce any insulin (the hormone that helps glucose enter the cells where it will be burnt to release its energy), whereas in type 2 (90% of cases) the cells don’t respond to insulin properly. High blood sugar levels cause a variety of complications such as glaucoma, cataract, skin ulcers, heart disease, high blood pressure, stroke and kidney failure to name just a few.
Hepatitis: Inflammation of the liver caused by a variety in causes, most commonly viruses (hepatitis A, B, C), chronic excessive alcohol intake, and prescription and recreational drugs. Acute hepatitis can be fatal, heal on its own or take a chronic turn. Chronic hepatitis is often subclinical in presentation with few or no symptoms at all, but more often than not leads to scar formation (fibrosis) or chronic liver failure (cirrhosis) that cannot be cured unless the patients receive a liver transplant. Chronic hepatitis also increases the risk for developing liver cancer.
Obesity: The Body Mass Index (BMI) is used to classify people based on body weight and height into underweight, (BMI below 20) normal body weight (BMI between 20 and 25), overweight (BMI between 25 and 30) and obese (BMI above 30). Even though those ranges aren’t a law of nature and may be changed depending on future research, we still know that the heavier people get the more likely they are to develop diseases of the cardiovascular system, diabetes mellitus type II, and osteoarthritis. Currently approximately 1/3 of Americans are of normal weight, 1/3 is overweight, and 1/3 is considered obese.
Hypertension: Also known as high blood pressure. A blood pressure of 140/90 or above at rest is considered as hypertension. There are some known risk factors that increase people’s chances of getting high blood pressure, such as obesity, too much salt in the body, smoking, and lack of exercise. However, 85% of all people with high blood pressure have no known risk factor or underlying cause and the disease cannot be cured only modified. High blood pressure doesn’t cause symptoms for most patients for many years, which explains why it goes often undiagnosed for a long time. Untreated high blood pressure can lead to heart attack, stroke, blindness, and kidney failure
Holistic medicine: A system of alternative healthcare that considers the whole person, body, mind, and spirit, instead of focusing on physical symptoms only. There is, however, no consensus what holistic medicine actually is and does. For some practitioners it is the combination of mainstream medicine with traditional medicine and herbal remedies, for others the focus is more on working with the mind, spirit and emotions of the patients.