Thursday, July 6, 2017

[Second Opinion] "Dahan-dahan sa dahon-dahon"

by Gideon Lasco
Philippine Daily Inquirer 

We Filipinos have a rich heritage of herbal medicines. Long before Dr. Nelia Maramba’s pioneering research and the Department of Health’s “Sampung Halamang Gamot,” Filipinos have been using herbs as remedies. In my own research, I encountered pine needles being used for contraception in the Cordilleras, kamangyan as treatment for asthma in Leyte, and the popular tawa-tawa for dengue all over the country.

In some way, this is good because many of our common ailments do not really require medication. Most cases of cough and cold, for instance, will get better even without any treatment, and patients end up attributing their recovery to whatever they were taking — be it an antibiotic, a vitamin, or an herbal medicine. Moreover, beyond a placebo effect, many herbs have very real benefits, as more and more scientific research is revealing.

But our soft spot for herbal medicines is being capitalized upon by various companies to sell all kinds of products. Some of these products actually have very little “herbs” in them: Dr. Bryan Lim, an infectious disease fellow at the Philippine General Hospital whose quip inspired the title of this piece, laments that some “herbal” powders promising to treat diabetes actually make it worse because they’re mostly sugar.

Others, while having actual herbs, are marketed as wonder drugs that can cure all kinds of diseases. Despite disclaimers of having “no approved therapeutic claims,” these products often come with implicit and explicit claims that even some radio newscasters attest to: a different way of being bayaran.

What’s more worrisome is when these herbal products are being presented as cures for serious conditions, particularly cancer. It is bad enough that patients are made to pay for unproven therapies, but what makes it worse is when these products take patients away from proven treatments that could have saved their lives. Any kind of therapy has an opportunity cost, which is often missed out in people’s decision-making processes.

Finally, there is also a chance they can cause actual harm. Contrary to the public’s perception that herbal medicines are largely harmless, they can be overdosed — and they do have side effects. Herbal supplements, considered technically as “food” but are often taken as medicine, remain a regulatory grey area, making it hard to ensure safety.

The appeal of herbs, of course, comes from the long-held idea that “nature heals.” To a certain extent, there is truth to this: A nutritious diet, coupled by a healthy lifestyle, can certainly make a big difference to our health. The industrialization of food and today’s sedentary lifestyles, on the other hand, have undeniably contributed to the rise of noncommunicable diseases.

But we must also bear in mind that the past was no Garden of Eden. Even when everything was “organic,” people had cancer, and it cannot be denied that modern medicine, with its vaccines, antibiotics, and novel technologies, has saved millions, if not billions, of lives.

On top of this discourse of “natural vs. artificial,” the appeal of herbs lies in the power of testimony. For scientists to be able to say something conclusive, they demand rigorous clinical trials—not just anecdotal evidence or animal studies. For many, however, a blog post can be more convincing—and celebrities more authoritative. Desperation, of course, can predispose people to cling to false hopes.

Having said all that, I have to stress that we should be open to the potential of herbal medicines, and thus support further research to validate their uses. But what we should be against is making false claims and raising expectations as to what they can do. Toward this end, government agencies and medical societies should be vigilant and critical in the way certain products are advertised. (This, by the way, also applies to pharmaceuticals — but that’s for another piece.)

Meanwhile, we must strive to create an environment of critical thinking: one that will empower the public to make informed health choices. When it comes to herbal medicines—as with all kinds of promised cures — a dose of healthy skepticism will go a long way.

Originally published in the Philippine Daily Inquirer:

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