Thursday, December 25, 2014

Noni juice and the vulnerability of the Filipino to anything 'herbal'

by Gideon Lasco, MD

In the 1990s, juice from the noni fruit (Morinda citrifolia), popularly known as "Noni juice" became a very popular product with its promise as a panacea or 'cure-all', with purported benefits ranging from cancer cure to increased vitality. Until now, this product lingers in some drugstores and is still being marketed in the Internet as a wonder supplement. However, this fad has been replaced by subsequent others - such as mangosteen and mahogany seeds.

The trend we observe is that first, a product emerges in public consciousness by word-of-mouth and heavy marketing. When this word-of-mouth streams to the level of households, a lot of people, particularly women and those in the older age groups would patronize it. Only after several months or years in which the promised claims have not materialized will people discontinue buying these products. By then, the unwitting family would have lost thousands which could have been used for proven "wellness" therapies such as vaccines. By then, the company that sold the product would have made enough profit to move on to promote the next herbal superstar.

In the case of noni juice, a close examination of its nutritional content reveals that the micronutrient (i.e. vitamin and mineral) content of a noni fruit is just similar to that of a raw orange. All its claims were not substantiated by numerous experiments and trials.

Here an interesting observation is seen: while scientific inquiry puts more emphasis on evidence derived from experimentation and tends to ignore anecdotal evidence, the public is actually more likely to listen to anecdotes of healing. For them it is more tangible and more believable that Neighbor Juan dela Cruz had a tumor that disappeared after he drank noni juice compared to a randomized-control trial of several hundred participants drinking noni juice that found no evidence of its efficacy against cancer. Only "personal experience" is weighed heavier than "anecdotal evidence" by the people, hence, only after months of experience of benefit (or lack) will they decide to continue or discontinue a product. This hierarchy of evidence means that Western medicine still has a lot of steps to take in winning the trust of the public. 

Paradoxically, any highfalutin or scientific-sounding name such as "L-Carnitine" also gets high marks from the public. But this is the topic of another essay.

The vulnerability of Filipinos to anything 'herbal' may be traced to our folk medicine heritage. Long before Western medicine arrived in our shores by way of Spain and America, our ancestors sought ways to cure our illnesses and ailments. As in many other cultures, they looked to the plants and trees in our forests. Some proved to be effective and have since been validated by scientific experiments. Regardless of scientific evidence, however, we value these homegrown efforts to cure our ailments. We have a deep cultural, emotional attachment to these therapies, perhaps reminding us of lola brewing oregano or lagundi leaves as treatment for cough.

It is not just our cultural heritage that makes us sympathetic to herbal products. The modernist ideal of going back to nature, which has its roots in New Age philosophy and a heightened attention to health and the body, has also lent its support to herbal products, vis-a-vis the 'artificial' pharmaceuticals. 

Businesses, particularly ' nutriceutical' companies, can abuse this emotional attachment to herbals by invoking them heavily in their marketing campaigns and sensationalizing the range and potency of their therapeutic effects. The disclaimer "No approved therapeutic claims" cannot compete against images of healing that advertisements portray. This is what we see now. There is need for legislation to curb this, as well as public information campaigns to counteract the unopposed one-sided information in favor of these herbal products. 

The rationale for legislation, as well as public information campaigns, is this: there potential harm in using in 'herbal medicines'. Being pharmacologically active substances, just like any other drug they can lead to overdose, toxicity and poisoning, as well as allergic reactions. Since a doctor usually asks a victim of overdose if he or she has ingested any drug and people don't classify these herbals as such, these cases usually go undocumented or undiagnosed. It must be conceded however that these are rare cases and most herbal medicines do not cause substantial harm to the one taking them.

A bigger danger, however, is if herbal medicines take away the opportunity for a patient to avail of medical treatment and the money to finance therapy that is warranted. For example, doctors see many cases of people consulting for cancer that has already reached Stage IV (the cancer has spread to other parts of the body). When asked why it took a long time for them to seek consult, it is not unusual for patients to say that they decided to first try out a particular herbal supplement. But when the tumor continued to grow, that was the time when they decided to finally consult. Here's the rub: Stage I or II cancer if detected and treated early usually has good prognosis, with a growing number of cancer survivors even living healthy lives and normal lifespans. Stage IV cancer usually kills within several months or few years.

On the positive other hand, emotional attachment to herbals can be used in a healthy way. It could win public sympathy for the research and development (R&D) efforts to identify, develop, and market herbal medicines and that work. This thrust has the potential to reduce our dependence on the mainstream pharmaceutical industry. Cough syrups, many of which are themselves not backed by scientific evidence, are better replaced with a nice brew of lagundi leaves. The Department of Health in 2003 and 2007 launched campaigns for the "Sampung Halamang Gamot" but this is largely under-utilized. 

That we have a wealth of ethnopharmacology is clear. In 1949, soil from Iloilo was isolated to have metabolic products that served as the precursor of Erythromycin, a very important antibiotic and Filipino scientists continue to research on the potential benefits of various plants. The late National Scientist Dr. Conrado Dayrit pioneered research on Virgin Coconut Oil and studies are beginning to show its benefits in various ways. It is already routine practice in the Philippine General Hospital to include VCO in the nutritional upbuilding of admitted children in the Pediatrics wards.

The legacy of our herbal healers has definitely persisted to the present time. It remains to be seen if it will ultimately be for the profit of some, or for the benefit of all.

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