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First, Do No Harm

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The medical profession has looked down on alternative medicine for decades, is it time for a second opinion?

On any Sunday, the plaza in front of Quiapo church in Manila is bustling with the illegal drug trade. People walk timidly up to stalls, exchange a few words with toothless seller-women, and hurriedly shove packages wrapped in newspaper into bags and pockets before walking away with feigned nonchalance.

Alternative MedicineSold alongside plaster figurines of the Virgin Mary and the Black Nazarene, bundles of dried leaves and curious liquids line makeshift stalls in the plaza. Not quite the marijuana, methamphetamine, and abortion pills that the city’s most pious district is also known for; but for the stigma that surrounds them, herbal medicine may as well be.

Filipinos have been healing themselves with tree bark, leaves, and roots for centuries. Mankind has been doing it for far longer—as early as the 6th millennium BC in Sumeria. Greek physician and Father of Medicine Hippocrates is said to have advocated herbs combined with a proper diet and fresh air. For all that, herbal medicine and other ancient healing techniques have been lumped together with New Age cures like pinhole sunglasses and faith healing. The blame seems to rest squarely on the West.

Is Nothing Sacred?
Former RP Health Secretary Jaime Galvez-Tan, an advocate of holistic or integrative medicine, says that the medical philosophies of the East and West developed along different streams. Although the Greeks believed in a sound mind in a sound body, Western medicine eventually focused on just physical health. Asian medicine, on the other hand, believed health is in keeping mind, body, and spirit in harmony.

After the Industrial Revolution in Europe, physicians began to see the heart as just a pump, and the human body as just a system of interdependent systems. With the mysteries of the body slowly being unraveled by science, there was no more spirituality, merely symptoms.

Imperialism and colonialism brought with them the West’s preference for laboratory-based medicine. The Flexner Report, published in 1910, set the course for American medicine for the next 71 years. North American medicine would stick to cures developed in the laboratory, and tested according to mainstream scientific principles. Everything else was considered folk superstition and quackery.

This was not the malicious eradication of culture, physicians just didn’t know any better. Or maybe they did, too much so. After all, they had hard science behind them.

Seeking Second Opinions
It wasn’t until the 1970s that Western science, spurred by the West’s sudden fascination with yoga and meditation, began to take a closer look at the mystical healing arts of Asia. Dr Galvez-Tan says that scientists were surprised to find that meditation did lower the heart rate and help manage pain.

This was also the decade during which the World Health Organization (WHO) redefined health as “not just the absence of disease or infirmity” but as a state of total physical, mental, and social wellness. Realizing that modern medicine was often inaccessible in developing countries, the WHO also advocated the use of traditional medicine. “After all, it’s what was being used already,” Galvez-Tan says.

The paradigm shift from mere physical health also helped the medical profession deal with factors that cause disease, not just the symptoms. Avoiding stress and eating a balanced diet to avoid heart disease is common sense now, but until then, heart disease was managed through pure chemistry.

It was only in 1991 that the US National Health Institute (US NHI) started to take a serious look at alternative medicine, or what it now calls Complementary and Alternative Medicine (CAM). It has since conducted hundreds of clinical tests to see whether herbal medicines, acupuncture, yoga, and other supposed quackcures work.

Although more clinical tests are needed, some traditional techniques do show promise. Acupuncture, for example, has been found to help the management of lower-back pain, while plants like St. John’s Wort are useful against mild depression. Despite these developments, the US NHI insists on labeling them complementary and alternative medicine until evidence-based science says otherwise, a label that Dr Galvez-Tan finds problematic.

“I think it’s a derogatory term. It’s like it’s second-class medicine,” he says, preferring the term used by the WHO, integrative medicine. “Let the two streams happen together.”

Heal Thyself
If figures are to be trusted, that seems to be happening anyway, with or without the doctor’s consent. According to a 2007 study by the US National Commission on Complementary and Alternative Medicine, 38.3% of American adults use some form of CAM.

In the Philippines, numbers could be much higher. Dr Romulo De Villa, dean of the Pamantasan ng Lungsod ng Maynila (City University of Manila) College of Medicine says that some 40% of his patients take food supplements, while up to 80% use some form of alternative medicine ranging from prayer to Pranic healing. He adds that patients, knowing their doctor may prohibit them from using alternative cures, keep it to themselves.

Why the opposition? De Villa, who prescribes herbal medicine to some cancer patients, says that it is the fear of the unknown.

Doctors are trained to treat patients by the book, and not without reason. Untested cures could be worse than the disease. Some herbs and mushrooms damage the liver and kidneys, for example. That’s why De Villa, who is an oncologist by specialization, only prescribes nutraceuticals—organic medicine created to pharmaceutical standards.

One pill, based on the Cordyceps sinensis fungus, has shown promise in Chinese clinical trials. It was discovered to improve heart rate recovery, maximize oxygenation of the blood, and lower the mean heart-rate of patients. Dr De Villa gets the medicine from a pharmaceutical company with a team of around 125 doctors and scientists doing research on herbal medicine.

Dr Galvez-Tan offers a less altruistic reason than not wanting to cause undue side effects: commissions from pharmaceutical companies. “If I prescribe this (patented drug), I get a bonus,” he explains, adding that this “oblique bribery” is an ethical issue that many doctors have to grapple with.

Pharmaceutical companies would lose revenue if cheaper herbal medicine could do exactly what their patented drugs could. Galvez-Tan says the effects of the cholesterol-lowering drug atorvastatin, for example, can be replicated by taking turmeric, a kind of ginger. Citing studies that have shown that turmeric works, he laments, “I thought they wanted evidence-based medicine? There’s already evidence. Why are they ignoring it?

Lab tests have already shown that ginger and garlic can kill the tuberculosis bacteria, he says, “but they’re so common. There’s no money there.”

Signs of Life
The medical community is slowly coming around, however. Both Galvez-Tan and De Villa note that more medical specialist societies in the Philippines have shown interest in integrative medicine. De Villa says that more and more doctors are going into the “gray area” between mainstream and alternative medicine, especially since patients have started asking about them.

The Department of Health has also been promoting 10 medicinal herbs, while government has been conducting clinical trials to prove that they work. The National Kidney and Transplant Institute, where De Villa has a clinic, now prescribes Sambong (Blumea balsamifera) for gallstones. “That already has therapeutic claims,” Galvez-Tan says, meaning the cure has gone through double-blind, random, controlled trials, and passed.

It costs 20 million pesos to conduct clinical trials for each herbal cure and for each symptom it supposedly cures, and the cost has made Philippine research slow. He says, however, that government has allocated some 20 billion pesos for the project, so there is hope. Six have been certified therapeutic, but he says, “We’re not really doing enough.”

Galvez-Tan adds that with over 1,200 herbs and plants in the Philippines, herbal medicine could be a multi-billion-dollar industry for the country, as it has become for Thailand and Singapore.

Some Philippine medical schools have also followed the lead of Stanford, Harvard, and Johns Hopkins University, including electives on traditional and alternative medicine in their curricula.

Galvez-Tan says that of 41 medical schools in the country, De La Salle University, the University of the Philippines, and the University of the East are currently exploring integrative medicine. He also runs the Traditional and Integrative Medicine Clinic at the Philippine General Hospital, the country’s foremost government-run hospital.

Snake Oil, Supplements
While doctors have been cautious about prescribing food supplements and herbal cures, the food industry is just the opposite when it comes to flooding the market with its new wonder foods.

Food supplements and supplemented food have enjoyed brisk sales in recent years, especially those that promise to give people fairer skin, healthier eyes, and slimmer bodies. With all these claims (but with the loophole of being labeled as having “no therapeutic claims”), how can a consumer find the most effective product?

“The consumer doesn’t know, and will not know,” De Villa says, adding that “even those who can know aren’t allowed to.” He was recently commissioned to look into claims that the L-carnitine in a certain product affected metabolism. The manufacturing company filed studies to support their claims with the RP Food and Drug Administration—but De Villa was barred from examining them. The company had an agreement with the FDA to keep the study private.

Galvez-Tan adds that because of the cost of testing, many companies do not bother to conduct them since they’re protected by the “no therapeutic claims” label. After all, they’re already making money even without proving their claims, he says. He admonishes that, although this mindset means an easy profit, “It’s destroying the industry.”

De Villa puts it another way. “All those juice products in the market, they don’t really work.” He points out that without proper testing, they are all just pixie dust, fortified with an arbitrary, and usually minimal, amount of a certain substance. He cites green-tea-based drinks as an example. Lab tests have suggested that catechins “trigger cancer cells to commit suicide,” he says, but if you get your catechins from the grocery store, “Let’s not expect it will perform like in the studies.”

Alternative medicine is only now being rediscovered by the medical and scientific establishment, and it will be years before they become accepted treatments. Until then, the doctors say, it is still best to consult a physician before taking alternative treatments. They may, after all, be beneficial in concert with laboratory-proven drugs.

As for claims made by food supplement manufacturers, it’s best to take them with a grain of salt—which, incidentally, is an excellent natural antiseptic.

Print ed: 12/09

 

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