MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

herbal medicine

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The use of so-called alternative medicine (SCAM) is common among breast cancer patients, but less is known about whether SCAM influences breast cancer survival. The primary aim of this recent study from Tunesia was to determine the impact of self-use of herbs on the overall survival of women with breast cancer.

The researchers conducted a prospective study including 110 patients with breast cancer. All patients were questioned about their usage of herbal remedies. The demographic data and the overall survival of the patients were then analyzed.

The average age was 51 years (30-80 years old). In total, 37 had metastatic disease (33.6%), and 48 patients had taken plant-based treatments (43.6%). Of those women, 19 patients consumed Graviola (39.6%) and 29 Alenda (60.4%). Overall survival rates at 3 years and at 5 years were 96.2% and 82.4% in the absence of herbal medicine usage versus 78.5% and 78.5% in the presence of herbal medicine use (p = 0.015).

The authors concluded that self-medication with Graviola or Alenda may be associated with an increase of death risk in patients with breast cancer. Further studies are needed to confirm these results.

This is only a small and not very rigorous case-control study. In itself, it would be far from conclusive. What renders it relevant, however, is the fact that its findings do by no means stand alone. We have seen several times on this blog that SCAM use can shorten the life of cancer patients, e.g.:

So, perhaps it is true? Perhaps using SCAM is not such a good idea, if you are suffering from cancer!

The mechanisms of such detrimental effects are not difficult to imagine. They might include direct effects on the cancer, interactions with prescribed drugs, delay of cancer diagnosis, or less strict adherence to the anti-cancer treatments.

The Chinese have made several attempts to persuade us that their traditional remedies are effective for COVID-19 infections. Here is yet another one. This review summarised the evidence of the therapeutic effects and safety of Chinese herbal medicine (CHM) used with or without conventional western therapy for COVID-19. All clinical studies of the therapeutic effects and safety of CHM for COVID-19 were included. The authors

  • summarized the general characteristics of included studies,
  • evaluated the methodological quality of the randomized controlled trials (RCTs) using the Cochrane risk of bias tool,
  • analyzed the use of CHM,
  • used Revman 5.4 software to present the risk ratio (RR) or mean difference (MD) and their 95% confidence interval (CI) to estimate the therapeutic effects and safety of CHM.

A total of 58 clinical studies were identified including;

  • 10 RCTs,
  • 1 non-randomized controlled trials,
  • 11 retrospective studies with a control group,
  • 12 case-series,
  • 24 case-reports.

All of the studies had been performed in China. No RCTs of high methodological quality were identified. The most frequently tested oral Chinese patent medicine, Chinese herbal medicine injection, or prescribed herbal decoction were:

  • Lianhua Qingwen granule/capsule,
  • Xuebijing injection,
  • Maxing Shigan Tang.

The pooled analyses showed that there were statistical differences between the intervention group and the comparator group (RR 0.42, 95% CI 0.21 to 0.82, six RCTs; RR 0.38, 95% CI 0.23 to 0.64, five retrospective studies with a control group), indicating that CHM plus conventional western therapy appeared to be better than conventional western therapy alone in reducing aggravation rate.

In addition, compared with conventional western therapy, CHM plus conventional western therapy had the potential advantages in increasing the recovery rate and shortening the duration of fever, cough, and fatigue, improving the negative conversion rate of nucleic acid test, and increasing the improvement rate of chest CT manifestations and shortening the time from receiving the treatment to the beginning of chest CT manifestations improvement.

For adverse events, the pooled data showed that there were no statistical differences between the CHM and the control groups.

The authors concluded that current low certainty evidence suggests that there maybe a tendency that CHM plus conventional western therapy is superior to conventional western therapy alone. The use of CHM did not increase the risk of adverse events.

One of the principles to remember here is this: RUBBISH IN, RUBBISH OUT. If you meta-analyze primary data that are rubbish, your findings can only be rubbish as well.

All one needs to know about the primary data entered into the present analysis is that there were no rigorous RCTs… not one! That means the evidence is, as the authors rightly but modestly conclude of LOW CERTAINTY. My conclusions would have been a little different:

  1. In terms of safety, the dataset is too small and unreliable to make any judgment.
  2. In terms of efficacy, there is no sound data that CHM has a positive effect.

As I don’t live in the UK at present, I miss much of what the British papers report about so-called alternative medicine (SCAM). Therefore, I am a bit late to stumble over an article on the business activities of our Royals. It brought back into memory a little tiff I had with Prince Charles.

The article in the Express includes the following passage:

The UK’s first professor of complementary medicine, Edzard Ernst, dubbed the Duchy Originals detox tincture — which was being sold on the market at the time — “outright quackery”.

The product, called Duchy Herbals’ Detox Tincture, was advertised as a “natural aid to digestion and supports the body’s elimination processes” and a “food supplement to help eliminate toxins and aid digestion”.

The artichoke and dandelion mix cost £10 for a 50ml bottle.

Yet, Professor Ernst said Charles and his advisers seemed to be ignoring the science in favour of relying on “make-believe” and “superstition”, and said the suggestion that such products could remove bodily toxins was “implausible, unproven and dangerous”.

He noted: “Prince Charles thus financially exploits a gullible public in a time of financial hardship.”

This passage describes things accurately but not completely. What actually happened was this:

Unbeknown to me and with the help of some herbalists, Duchy Originals had developed the ‘detox tincture’ during a time when I was researching the evidence about ‘detox’. Eventually, my research was published as a review of the detox concept:

Background: The concept that alternative therapies can eliminate toxins and toxicants from the body, i.e. ‘alternative detox’ (AD) is popular.

Sources of data: Selected textbooks and articles on the subject of AD.

Areas of agreement: The principles of AD make no sense from a scientific perspective and there is no clinical evidence to support them.

Areas of controversy: The promotion of AD treatments provides income for some entrepreneurs but has the potential to cause harm to patients and consumers.

Growing points: In alternative medicine, simplistic but incorrect concepts such as AD abound. AREAS TIMELY FOR RESEARCH: All therapeutic claims should be scientifically tested before being advertised-and AD cannot be an exception.

When I was asked by a journalist what I thought about Charles’ new ‘detox tincture’, I told her that it was not supported by evidence which clearly makes it quackery. I also joked that Duchy Originals could thus be called ‘Dodgy Originals’. The result was this newspaper article and a subsequent media storm in the proverbial teacup.

At Exeter University, I had just fallen out of favor because of the ‘Smallwood Report’ and the complaint my involvement in it prompted by Charles’ first private secretary (full story in my memoir). After the ‘Dodgy Originals story’ had hit the papers, I was summoned ominously to my dean, Prof John Tooke, who probably had intended to give me a dressing down of major proportions. By the time we were able to meet, a few weeks later, the MHRA had already reprimanded Duchy Originals for misleading advertising which took most of the wind out of Tooke’s sail. The dressing down thus turned into something like “do you have to be so undiplomatic all the time?”.

Several months later, I was invited by the Science Media Centre, London, to give a lecture on the occasion of my retirement (Fiona Fox, the head of the SMC, had felt that, since my own University does not have the politeness to run a valedictory lecture for me, she will organize one for journalists). In that short lecture, I tried to summarize 19 years of research which inevitably meant briefly mentioning Charles and his foray into detox.

When I had finished, there were many questions from the journalists. Jenny Hope from the Daily Mail asked, “You mentioned snake-oil salesmen in your talk, and you also mentioned Prince Charles and his tinctures. Do you think that Prince Charles is a snake-oil salesman?” My answer was brief and to the point: “Yes“. The next day, this was all over the press. The Mail’s article was entitled ‘Charles? He’s just a snake-oil salesman: Professor attacks prince on ‘dodgy’ alternative remedies‘.

The advice of Tooke (who by then had left Exeter) to be more diplomatic had evidently not borne fruits (but the tinctures were discreetly taken off the market).

Diplomatic or honest?

This has been a question that I had to ask myself regularly during my 19 years at Exeter. For about 10 years, I had tried my best to walk the ‘diplomatic route’. When I realised that, in alternative medicine, the truth is much more important than diplomacy, I gradually changed … and despite all the hassle and hardship it brought me, I do not regret the decision.

In March 2020, ITV reported that a faith healer has been accused of “exploiting” people’s anxiety about the coronavirus crisis by selling a “plague protection kit” for £91. Bishop Climate Wiseman, head of the Kingdom Church in Camberwell, south London, has promised his followers the small bottle of oil and piece of red yarn will protect them from Covid-19. In a blog post, Bishop Wiseman claimed his concoction of cedar wood, hyssop and scarlet yarn acts as “an invisible barrier to the powers of darkness”. He wrote: “It is by faith that you can be saved from the coronavirus pandemic by covering yourself with the divine plague protection oil and wearing the scarlet yarn on your body. That is why I want to encourage you, if you haven’t done so already, to get your divine plague protection kit today!”

He claimed that the remedy was based on a passage from chapter 14 of the Old Testament Book of Leviticus. It reads: “Then he is to take the cedar wood, the hyssop, the scarlet yarn, and the live bird, dip them into the blood of the dead bird and the fresh water, and sprinkle the house seven times. In this way, he will make atonement for the house, and it will be clean.”

Bishop Wiseman told the PA news agency the church had sold more than 1,000 of the kits. “This is based on the Bible – I’m a Christian and there is a way that the Bible says to protect us from plagues.” One can also buy miracle money house blessing oil and anointed oil for court cases. On the Kingdom Church’s website, it claims thousands of people have been healed from “all sorts” of sickness and disease since it was founded in 2005.

Now, the Charity Commission has appointed an interim manager to the church following concerns raised by the National Secular Society about ‘plague protection kits’ sold by its bishop. England and Wales’s charity regulator announced that it appointed an interim manager to The Kingdom Church GB in February, who will “consider the charity’s future operation and viability”.

Elsewhere, the oil is advertised as follows:

Plagues Divine Protection Anointing Oil Have you been battling with countless amount of fear due to an economical wide spread of plaques and viruses? Then this Anointing Oil is for you.

The Plagues Divine Protection Anointing Oil was created by Master Prophet, Prophet Climate Wiseman through divine guidance and instruction from the Holy Spirit. This oil contains two biblical integrant which is biblically proven to remove plagues of all kind. These two Integrants are Hyssop and Cedar wood. The Bible clearly tells us in the book of Leviticus 14:51-53 “Then he is to take the cedar wood, the hyssop, the scarlet yarn and the live bird, dip them into the blood of the dead bird and the fresh water, and sprinkle the house seven times. He shall purify the house with the bird’s blood, the fresh water, the live bird, the cedar wood, the hyssop and the scarlet yarn. Then he is to release the live bird in the open fields outside the town. In this way he will make atonement for anointedoils

The commission said it had “serious ongoing concerns” about the charity’s administration and the financial relationship with its two subsidiary companies. It found the charity does not have a bank account and charity funds have instead been deposited into the charity’s subsidiaries’ bank accounts. It is investigating the legality of this relationship. The commission only appoints interim managers to charities “after very careful consideration” if there is misconduct or mismanagement in the administration of a charity, or if it is necessary or desirable to protect the charity’s property.

The post originally included claims that “every coronavirus and any other deadly thing” would “pass over” those using the oil and yarn. It was later edited to remove some specific references to coronavirus, but continued to claim people could “be saved from every pandemic” by using the oil and string.

On 20 February 2021, I published on my blog a comment on a new study of an Ayurvedic remedy for COVID-19. The study was in my view suspect, and I expressed this as follows:

I have the following concerns or questions about this trial:

  • Why do the authors call it a pilot study? A pilot study is merely for testing the feasibility of a trial design and is not meant to yield definitive efficacy results.
  • The authors state that the patients were asymptomatic yet in the discussion they claim they were asymptomatic or mildly symptomatic.
  • Some of the effect sizes reported here are extraordinary and seem almost too good to be true.
  • The claim of no adverse effect is implausible; even placebos would cause perceived adverse effects in a percentage of patients.
  • If the study is solid and withstands the scrutiny of the raw data, it is of huge relevance for public health. So, why did the authors publish it in PHYTOMEDICINE, a relatively minor and little-known journal?

An article in The Economic Times’ reported this:

Patanjali Ayurved released what it called the first “evidence-based” medicine for Covid-19 on Friday. It claimed it has been “recognised by the WHO (World Health Organization) as an ayurvedic medicine for corona”. Patanjali promoter, yoga guru Baba Ramdev, released a scientific research paper in this regard at the launch, presided over by Union health minister Harsh Vardhan and transport minister Nitin Gadkari. The Ayurveda products maker said it has received a certification from the Ayush ministry. “Coronil has received the Certificate of Pharmaceutical Product (CoPP) from the Ayush section of Central Drugs Standard Control Organisation (CDSCO) as per the WHO certification scheme,” it said in a statement. Under the CoPP, Coronil can be exported to 158 countries, the company said, adding that based on the presented data, the ministry has recognised Coronil as medicine for “supporting measure in Covid-19”.

Am I the only one who fears that something is not entirely kosher about the study? (This is an honest question, and I would be pleased to receive answers from my readers)

What happened next is most puzzling. After putting it on Facebook several times, I got banned for 72 hours from posting this article or anything else on Facebook. When this period had elapsed, I put the article in question again on Facebook. Subsequently, I was banned again but this time for 7 days. Facebook gave the following explanation:

You can’t post or comment for 7 days

This is because your previous posts didn’t follow our Community Standards.

No one else can see these posts.

1 Mar

Your post goes against our Community Standards on misinformation that could cause physical harm

We usually offer the chance to request a review, and follow up if we’ve gotten decisions wrong.

We have fewer reviewers available at the moment because of the coronavirus (COVID-19) outbreak. We’re trying hard to prioritise reviewing content with the most potential for harm.

This means that we may not be able to follow up with you, though your feedback helps us do better in the future.

Thank you for understanding.

On Twitter, the hype had begun even before its text was available. Priti Gandhi, for instance, tweeted:

Yet another feather in India’s cap!! 1st evidence-based, CoPP-WHO GMP certified medicine for Covid-19 released today. Congratulations to @yogrishiramdev ji, @Ach_Balkrishna ji & the team of scie…

EDZARDERNST.COM An RCT on the efficacy of ayurvedic treatment on asymptomatic COVID-19 patients

________________________________

As I did not feel I had broken any rules, I protested against the bans each time. When the 2nd ban was over, I posted my article yet again and, sure enough, yesterday I got banned again, this time for 30 days. Here is how they let me know:

You can’t post or comment for 30 days

This is because you previously posted something that didn’t follow our Community Standards.

This post goes against our standards on misinformation that could cause physical harm, so only you can see it.

Learn more about updates to our standards. On Twitter, the hype had begun even before its text was available. Priti Gandhi, for instance, tweeted: Yet another feather in India’s cap!! 1st evidence-based, CoPP-WHO GMP certified medicine for Covid-19 released today. Congratulations to @yogrishiramdev ji, @Ach_Balkrishna ji & the team of scie…

EDZARDERNST.COM An RCT on the efficacy of ayurvedic treatment on asymptomatic COVID-19 patients

____________________________

As the reason for the ban always seems to be the Ayurvedic study, I suspect that some party interested in the product is behind the complaints that lead to the bans. I find it extraordinary that I can be banned repeatedly without having done anything wrong and without my objections ever being considered.

Has anyone else experienced similar things?
Can anyone shed more light on this mysterious story?
Is there anything I can do, except for objecting, which I have now done thrice?

 This study aimed to evaluate the effect of Traditional Chinese Medicine (TCM) on patients with gastric cancer following surgery and adjuvant chemotherapy in Taiwan. The cohort sampling data set was obtained from the Registry of Catastrophic Illness Patient Database, a research database of patients with severe illnesses from the National Health Insurance Research Database, Taiwan. Patients who had received a new diagnosis of gastric cancer and had undergone surgery were enrolled. the researchers matched TCM users and nonusers at a ratio of 1 : 3 based on the propensity score, and TCM users were also grouped into short-term and long-term users.

The number of TCM users and nonusers was 1701 and 5103 after applying the propensity score at a ratio of 1 : 3. Short-term users and long-term TCM users were independently associated with a decreased risk of death with HRs of 0.59 (95% confidence interval (CI), 0.55-0.65) and 0.41 (95% CI, 0.36-0.47), respectively, compared with TCM nonusers. The researchers also obtained similar results when they adjusted for covariates in the main model, as well as each of the additional listed covariates. They also observed similar HR trends in short-term users and long-term TCM users among men and women aged <65 years and ≥65 years. The most commonly prescribed single herb and herbal formula in our cohort were Hwang-Chyi (Radix Hedysari; 11.8%) and Xiang-Sha-Liu-Jun-Zi-Tang (15.5%), respectively.

The authors concluded that TCM use was associated with higher survival in patients with gastric cancer after surgery and adjuvant chemotherapy. TCM could be used as a complementary and alternative therapy in patients with gastric cancer after surgery and adjuvant chemotherapy.

This is an interesting study which seems well-done – except for one fatal mistake: even in the title, the authors imply a causal relationship between TCM and survival. Their conclusion has two sentences; the first one speaks correctly of an association. The second, however, not only implies causality but goes much further in suggesting that TCM should be used to prolong the life of patients. Yet, there are, of course, dozens of factors that could interfere with the findings or be the true cause of the observed outcome.

Anyone with a minimum of critical thinking ability should know that CORRELATION IS NOT CAUSATION; sadly, the authors of this study seem to be the exception.

On Twitter, the hype had begun even before its text was available. Priti Gandhi, for instance, tweeted:

Yet another feather in India’s cap!! 1st evidence-based, CoPP-WHO GMP certified medicine for Covid-19 released today. Congratulations to @yogrishiramdev ji, @Ach_Balkrishna ji & the team of scientists at Patanjali Research Institute. Your efforts have been successful!! #Ayurveda

So, what is it all about? This study included 100 patients and was designed to evaluate the impact of traditional Indian Ayurvedic treatment on asymptomatic patients with COVID-19 infection. It is a placebo-controlled randomized double-blind pilot clinical trial that was conducted at the Department of Medicine in the National Institute of Medical Sciences and Research, Jaipur, India.

The verum treatment consisted of:
  • 1 g of Giloy Ghanvati (Tinospora cordifolia)
  • 2 g of Swasari Ras (traditional herbo-mineral formulation)
  • 0.5 g of Ashwagandha (Withania somnifera)
  • 0.5 g of Tulsi Ghanvati (Ocimum sanctum)

The treatment was given orally to the patients in the treatment group twice per day for 7 days. Medicines were given in the form of tablets and each tablet weighed 500 mg. While Swasari Ras was administered in powdered form, 30 min before breakfasts and dinners, rest were scheduled for 30 min post-meals. Patients in the treatment group also received 4 drops of Anu taila (traditional nasal drop) in each nostril every day 1 h before breakfast. Patients in the placebo group received identical-looking tablets and drops, post-randomization, and double-blinded assortments. The RT-qPCR test was used for the detection of viral load in the nasopharyngeal and oropharyngeal swab samples of study participants during the study. Chemiluminescent immunometric assay was used to quantify serum levels of interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and high sensitivity C-reactive protein (hs-CRP) on day 1 and day 7 of the study. Patient testing negative for SARS-CoV-2 in the RT-PCR analysis was the primary outcome of this study.

By day three, 71.1 % and 50.0 % of patients recovered in the treatment and placebo groups, respectively. The treatment group witnessed 100 % recovery by day 7, while it was 60.0 % in the placebo group. Average fold changes in serum levels of hs-CRP, IL-6, and TNF-α in the treatment group were respectively, 12.4, 2.5 and 20 times lesser than those in the placebo group at day 7. There was a 40 % absolute reduction in the risk of delayed recovery from infection in the treatment group.

The authors concluded that Ayurvedic treatment can expedite virological clearance, help in faster recovery and concomitantly reduce the risk of viral dissemination. Reduced inflammation markers suggested less severity of SARS-CoV-2 infection in the treatment group. Moreover, there was no adverse effect observed to be associated with this treatment.

I have the following concerns or questions about this trial:

  • Why do the authors call it a pilot study? A pilot study is merely for testing the feasibility of a trial design and is not meant to yield definitive efficacy results.
  • The authors state that the patients were asymptomatic yet in the discussion they claim they were asymptomatic or mildly symptomatic.
  • Some of the effect sizes reported here are extraordinary and seem almost too good to be true.
  • The claim of no adverse effect is implausible; even placebos would cause perceived adverse effects in a percentage of patients.
  • If the study is solid and withstands the scrutiny of the raw data, it is of huge relevance for public health. So, why did the authors publish it in PHYTOMEDICINE, a relatively minor and little-known journal?

An article in The Economic Times’ reported this:

Patanjali Ayurved released what it called the first “evidence-based” medicine for Covid-19 on Friday. It claimed it has been “recognised by the WHO (World Health Organization) as an ayurvedic medicine for corona”.

Patanjali promoter, yoga guru Baba Ramdev, released a scientific research paper in this regard at the launch, presided over by Union health minister Harsh Vardhan and transport minister Nitin Gadkari.

The Ayurveda products maker said it has received a certification from the Ayush ministry. “Coronil has received the Certificate of Pharmaceutical Product (CoPP) from the Ayush section of Central Drugs Standard Control Organisation (CDSCO) as per the WHO certification scheme,” it said in a statement.

Under the CoPP, Coronil can be exported to 158 countries, the company said, adding that based on the presented data, the ministry has recognised Coronil as medicine for “supporting measure in Covid-19”.

Am I the only one who fears that something is not entirely kosher about the study? (This is an honest question, and I would be pleased to receive answers from my readers)

“Today, scientists note that the glycyrrhizic acid contained in this plant prevents the development of a new coronavirus, which the whole world is fighting against. Moreover, even a small concentration of an aqueous extract of licorice root has a neutralizing effect.”

These are the words of President Gurbanguly Berdymukhamedov of Turkmenistan. The plant he referred to is licorice. With is the promotion of a herbal solution for the pandemic, he is in good company:

  • Thailand’s health ministry approved the use of Andrographis Paniculata, commonly known as green chiretta, to treat patients who are in the early stages of a Covid-19 infection.
  • The health authorities of Tamil Nadu distributed herbal medicine to the general public as a preventive measure against Coronavirus disease.
  • Madagascar claims to have a cure for Covid-19, the herbal tea named Covid-Organics has the plant artemisia as an ingredient.
  • China has been using TCM alongside conventional treatment methods to treat Covid-19 patients. Some of the herbal formulations used in the treatment are:
    • Jinhua Qinggan Granule
    • Sheganmahuang decoction
    • Lianhuaqingwen capsule
    • Maxingshigan decoction
    • Xuebijing Injection
  • Indonesia is testing two herbal medicines: Cordyceps militaris, a fungus common in the Himalayas, and a herbal formulation comprising Ginger, gripeweed, Ngai camphor, and Andrographis paniculata.

And what about some evidence? In 2020, Medline listed 302 articles on herbal medicine for COVID-19. Here I selected just 10 of them to give you a flavor:

1st article

COVID-19 is the most recently discovered coronavirus infectious disease and leads to pandemic all over the world. The clinical continuum of COVID-19 varies from mild illness with non-specific signs and symptoms of acute respiratory disease to extreme respiratory pneumonia and septic shock. It can transmit from animal to human in the form of touch, through the air, water, utensils, fomite and feco-oral route blood. The pathogenesis and clinical features of COVID-19 be the same as the clinical manifestation associated epidemic Fever. In Unani medicine, various herbal drugs are described under the caption of epidemic disease. Great Unani scholar also Avicenna (980-1037 AD) recommended that during epidemic condition movement should be restricted, self-isolation, fumigation around the habitant with perfumed herbs (Ood, Kafoor, Sumbuluttib, Saad Kofi, Loban, etc.), and use of appropriate antidotes (Tiryaqe Wabai) and vinegar (Sirka) as prophylaxis. Herbal approach is based on single (Unnab-Ziziphus jujuba, Sapistan-Cordia myxa, Bahidana-Cydonia oblonga, Khatmi-Althea officinalis, Khubazi-Malva sylvestris, Zafran-Crocus sativus, Sibr-Aloe barbedensis, Murmuki-Commiphora myrrha, Darchini-Cinnamomum zeylanicum, Qaranfal-Syzygium aromaticum, Rihan-Oscimum sanctum, Habtus Sauda-Nigella sativa, Aslus Sus-Glycyrrhiza glabra, Maghze Amaltas-Cassia fistula and Adusa-Adhatoda vasica) and compound drugs (Habbe Bukhar, Sharbat Khaksi, Sharbat Zanjabeel, Naqu Nazla, Majoon Chobchini, Jawrish Jalinus and Khamira Marvareed) most of them are claimed for anti-viral, anti-pyretic, blood purifier, cardioprotective and expectorant activities. Traditionally most of the herbal practitioners are using it.

2nd article

According to the World Health Organization (WHO), viral diseases continue to rise, and pose a significant public health problem. Novel coronavirus disease (COVID-19) is an infectious disease caused by SARS-CoV-2. The pathogenesis and clinical manifestations of COVID-19 is close to Amraz-e-Wabai (epidemic diseases) which was described by Hippocrates, Galen, Aristotle, Razes, Haly Abbas, Avicenna, Jurjani etc. Presently, there is no specific or challenging treatment available for COVID-19. Renowned Unani Scholars recommended during epidemic situation to stay at home, and fumigate the shelters with aromatics herbs like Ood kham (Aquilaria agallocha Roxb.), Kundur (Boswellia serrata Roxb), Kafoor (Cinnamomum camphora L.), Sandal (Santalum album L), Hing (Ferula foetida L.) etc. Use of specific Unani formulations are claimed effective for the management of such epidemic or pandemic situation like antidotes (Tiryaqe Wabai, Tiryaqe Arba, Tiryaqe Azam, Gile Armani), Herbal Decoction (Joshandah), along with Sharbate Khaksi, Habbe Bukhar, Sharbate Zanjabeel, Khamira Marwareed, Jawarish Jalinus, and Sirka (vinegar). Such drugs are claimed for use as antioxidant, immunomodulatory, cardiotonic, and general tonic actions. The study enumerates the literature regarding management of epidemics in Unani medicine and attempts to look the same in the perspective of COVID-19 prevention and management.

3rd article

Unani system of medicine is based on the humoral theory postulated by Hippocrates, according to him the state of body health and disease are regulated by qualitative and quantitative equilibrium of four humours. Amraz-e-Waba is an umbrella term which is used in Unani medicine for all types of epidemics (smallpox, measles, plague, Hameer Saifi, influenza, Nipaha, Ebola, Zika, and 2019 novel coronavirus, etc.) mostly fatal in nature. The coronavirus disease 2019 (COVID-19) is a severe acute respiratory infection, and the pathogenesis and clinical features resemble with those of Nazla-e-Wabaiya (influenza) and Zatul Riya (pneumonia) which were well described many years ago in Unani text such as high-grade fever, headache, nausea and vomiting, running nose, dry cough, respiratory distress, alternate and small pulse, asthenia, foul smell from breath, insomnia, frothy stool, syncope, coldness in both upper and lower extremities, etc. The World Health Organization declared COVID-19 as a global emergency pandemic. Unani scholars like Hippocrates (370-460 BC), Galen (130-200 AD), Rhazes (865-925 AD), and Avicenna (980-1037 AD) had described four etiological factors for Amraz-e-Waba viz., change in quality of air, water, Earth, and celestial bodies, accordingly mentioned various preventive measures to be adopted during epidemics such as restriction of movement, isolation or “quarantena”, and fumigation with loban (Styrax benzoin W. G. Craib ex Hartwich.), sandalwood (Santalum album L.), Zafran (Crocus sativus L.), myrtle (Myrtus communis L.), and roses (Rosa damascena Mill.) and use of vinegar (sirka) and antidotes (Tiryaq) as prophylaxis, and avoiding consumption of milk, oil, sweet, meat, and alcohol. This review focuses and elaborates on the concept, prevention, and probable management of COVID-19 in the light of Amraz-e-Waba.

4th article

Background: Current recommendations for the self-management of SARS-Cov-2 disease (COVID-19) include self-isolation, rest, hydration, and the use of NSAID in case of high fever only. It is expected that many patients will add other symptomatic/adjuvant treatments, such as herbal medicines.

Aims: To provide a benefits/risks assessment of selected herbal medicines traditionally indicated for “respiratory diseases” within the current frame of the COVID-19 pandemic as an adjuvant treatment.

Method: The plant selection was primarily based on species listed by the WHO and EMA, but some other herbal remedies were considered due to their widespread use in respiratory conditions. Preclinical and clinical data on their efficacy and safety were collected from authoritative sources. The target population were adults with early and mild flu symptoms without underlying conditions. These were evaluated according to a modified PrOACT-URL method with paracetamol, ibuprofen, and codeine as reference drugs. The benefits/risks balance of the treatments was classified as positivepromisingnegative, and unknown.

Results: A total of 39 herbal medicines were identified as very likely to appeal to the COVID-19 patient. According to our method, the benefits/risks assessment of the herbal medicines was found to be positive in 5 cases (Althaea officinalis, Commiphora molmol, Glycyrrhiza glabra, Hedera helix, and Sambucus nigra), promising in 12 cases (Allium sativumAndrographis paniculataEchinacea angustifolia, Echinacea purpurea, Eucalyptus globulus essential oil, Justicia pectoralis, Magnolia officinalisMikania glomerataPelargonium sidoidesPimpinella anisumSalix sp, Zingiber officinale), and unknown for the rest. On the same grounds, only ibuprofen resulted promising, but we could not find compelling evidence to endorse the use of paracetamol and/or codeine.

Conclusions: Our work suggests that several herbal medicines have safety margins superior to those of reference drugs and enough levels of evidence to start a clinical discussion about their potential use as adjuvants in the treatment of early/mild common flu in otherwise healthy adults within the context of COVID-19. While these herbal medicines will not cure or prevent the flu, they may both improve general patient well-being and offer them an opportunity to personalize the therapeutic approaches.

5th article

Recently, the novel life-threatening coronavirus infection (COVID-19) was reported at the end of 2019 in Wuhan, China, and spread throughout the world in little time. The effective antiviral activities of natural products have been proved in different studies. In this review, regarding the effective herbal treatments on other coronavirus infections, promising natural products for COVID-19 treatment are suggested. An extensive search in Google Scholar, Science Direct, PubMed, ISI, and Scopus was done with search words include coronavirus, COVID-19, SARS, MERS, natural product, herb, plant, and extract. The consumption of herbal medicine such as Allium sativum, Camellia sinensis, Zingiber officinale, Nigella sativa, Echinacea spp. Hypericum perforatum, and Glycyrrhiza glabra, Scutellaria baicalensis can improve the immune response. It seems that different types of terpenoids have promising effects in viral replication inhibition and could be introduced for future studies. Additionally, some alkaloid structures such as homoharringtonine, lycorine, and emetine have strong anti-coronavirus effects. Natural products can inhibit different coronavirus targets such as S protein (emodin, baicalin) and viral enzymes replication such as 3CLpro (Iguesterin), PLpro (Cryptotanshinone), helicase (Silvestrol), and RdRp (Sotetsuflavone). Based on previous studies, natural products can be introduced as preventive and therapeutic agents in the fight against coronavirus.

6th article

Background: The aim of the present review is to provide basic knowledge about the treatment of Coronavirus via medicinal plants. Coronavirus (COVID-19, SARS-CoV, and MERS-CoV) as a viral pneumonia causative agent, infects thousands of people in China and worldwide. There is currently no specific medicine or vaccine available and it is considered a threat to develop effective novel drug or anti-coronavirus vaccine treatment. However, natural compounds to treat coronaviruses are the most alternative and complementary therapies due to their diverse range of biological and therapeutic properties.

Methods: We performed an open-ended, English restricted search of Scopus database, Web of Science, and Pubmed for all available literature from Jan-March, 2020, using terms related to phytochemical compounds, medicinal plants and coronavirus.

Results: The view on anti-coronavirus (anti-CoV) activity in the plant derived phytochemicals and medicinal plants give the strong base to develop a novel treatment of corona virus activity. Various phytochemicals and medicinal plant extracts have been revised and considered to be the potential anti-CoV agents for effective control and future drug development. We discuss some important plants (Scutellaria baicalensis, Psorothamnus arborescens, Glycyrrhiza radix, Glycyrrhiza uralensis , Lycoris radiate, Phyllanthus emblica, Camellia sinensis, Hyptis atrorubens Poit, Fraxinus sieboldiana, Erigeron breviscapus, Citri Reticulatae Pericarpium, Amaranthus tricolor, Phaseolus vulgaris, Rheum palmatum, Curcuma longa and Myrica cerifera) emerged to have broad spectrum antiviral activity.

Conclusion: Nigella sativa has potent anti-SARS-CoV activity and it might be useful souce for developing novel antiviral therapies for coronaviruses.

7th article

COVID-19 has been declared a pandemic by WHO on March 11, 2020. No specific treatment and vaccine with documented safety and efficacy for the disease have been established. Hence it is of utmost importance to identify more therapeutics such as Chinese medicine formulae to meet the urgent need. Qing Fei Pai Du Tang (QFPDT), a Chinese medicine formula consisting of 21 herbs from five classical formulae has been reported to be efficacious on COVID-19 in 10 provinces in mainland China. QFPDT could prevent the progression from mild cases and shorten the average duration of symptoms and hospital stay. It has been recommended in the 6th and 7th versions of Clinical Practice Guideline on COVID-19 in China. The basic scientific studies, supported by network pharmacology, on the possible therapeutic targets of QFPDT and its constituent herbs including Ephedra sinicaBupleurum chinensePogostemon cablinCinnamomum cassiaScutellaria baicalensis were reviewed. The anti-oxidation, immuno-modulation and antiviral mechanisms through different pathways were collated. Two clusters of actions identified were cytokine storm prevention and angiotensin converting enzyme 2 (ACE2) receptor binding regulation. The multi-target mechanisms of QFPDT for treating viral infection in general and COVID-19 in particular were validated. While large scale clinical studies on QFPDT are being conducted in China, one should use real world data for exploration of integrative treatment with inclusion of pharmacokinetic, pharmacodynamic and herb-drug interaction studies.

8th article

In December 2019, a novel coronavirus SARS-CoV-2, causing the disease COVID-19, spread from Wuhan throughout China and has infected people over 200 countries. Thus far, more than 3,400,000 cases and 240,000 deaths have occurred worldwide, and the coronavirus pandemic continues to grip the globe. While numbers of cases in China have been steadying, the number of infections outside China is increasing at a worrying pace. We face an urgent need to control the spread of the COVID-19 epidemic, which is currently expanding to a global pandemic. Efforts have focused on testing antiviral drugs and vaccines, but there is currently no treatment specifically approved. Traditional Chinese medicine (TCM) is grounded in empirical observations and the Chinese people use TCM to overcome these sorts of plagues many times in thousands of years of history. Currently, the Chinese National Health Commission recommended a TCM prescription of Qing-Fei-Pai-Du-Tang (QFPDT) in the latest version of the “Diagnosis and Treatment guidelines of COVID-19” which has been reported to provide reliable effects for COVID-19. While doubts about TCM still exist today, this review paper will describe the rationalities that QFPDT is likely to bring a safe and effective treatment of COVID-19.

9th article

The fight against the novel coronavirus pneumonia (namely COVID-19) that seriously harms human health is a common task for all mankind. Currently, development of drugs against the novel coronavirus (namely SARS-CoV-2) is quite urgent. Chinese medical workers and scientific researchers have found some drugs to play potential therapeutic effects on COVID-19 at the cellular level or in preliminary clinical trials. However, more fundamental studies and large sample clinical trials need to be done to ensure the efficacy and safety of these drugs. The adoption of these drugs without further testing must be careful. The relevant articles, news, and government reports published on the official and Preprint websites, PubMed and China National Knowledge Infrastructure (CNKI) databases from December 2019 to April 2020 were searched and manually filtered. The general pharmacological characteristics, indications, adverse reactions, general usage, and especially current status of the treatment of COVID-19 of those potentially effective drugs, including chemical drugs, traditional Chinese medicines (TCMs), and biological products in China were summarized in this review to guide reasonable medication and the development of specific drugs for the treatment of COVID-19.

10th article

Objective: To analysis the medication characteristics of the prescriptions issued via open channel by the National and Provincial Health Committee and the State Administration of Traditional Chinese Medicine in treating coronavirus disease 2019 (COVID-19).

Methods: We collected the data of traditional Chinese medicine related to treatment plans published by the National and Provincial Health Committee and the State Administration of Traditional Chinese Medicine from the start of COVID-19 outbreak to February 19, 2020. The frequency analysis, cluster analysis and association analysis were performed.

Results: The study collected 4 national and 34 regional prevention and treatment plans, 578 items, 84 traditional Chinese formulations, 60 Chinese patent medicines, and 230 Chinese herbs. The high frequently used herbs were Liquorice, Scutellariabaicalensis, Semen armeniacaeamarae, and Gypsum. The commonly used traditional formulations included Maxing Shigan decoction, Yin Qiao powder, and Xuanbai Chengqi decoction. The Chinese patent drugs included Angong Niuhuang pill, Xuebijing injection, and Lianhua Qingwen capsule. The most common paired medications were Ephedra and Semen armeniacaeamarae, Fructusforsythiae and Liquorice. Two core combinations and one novel formula were discovered in the study.

Conclusions: Yin Qiao powder and Huopo Xialing decoction are the basic formulations for Weifen syndrome of COVID-19. In addition, Maxing Shigan decoction, Liang Ge powder, Qingwen Baidu decoction and Da Yuan decoction are the basic formulations for Qifen syndrome of COVID-19. The main medication characteristics are clearing heat, entilating lung, removing toxicity and removing turbidity. It shows that removing toxicity and eliminating evil are the prescription thought in treating epidemic disease of traditional Chinese medicine.

Confused?

Me too!

What seems to emerge is this:

  • ‘Herbalists and Co’ did not wait long to jump on the corona bandwagon.
  • They managed to confuse not just you and me, but even politicians, presidents, and their advisers.
  • They produced a plethora of articles implying that an endless array of herbs might be effective.
  • In doing so, no clear consensus emerged as to which herbs are the most promising.
  • Sound evidence seems to be not available.
  • Clinical trials are slow to start or not even planned.
  • Everything is based on more or less wild extrapolation.
  • Much of what is being published is borderline irresponsible.
  • YET, IT MUST BE GOOD FOR BUSINESS!

Turmeric is certainly a plant with fascinating properties; we have therefore discussed it before. Reseach into turmeric continues to be active, and I will continue to report about new studies.

This study was aimed at estimating the effect of turmeric supplementation on quality of life (QoL) and haematological parameters in breast cancer patients who were on Paclitaxel chemotherapy. In this case series with 60 participants, QoL was assessed using a standard questionnaire and haematological parameters were recorded from the patients’ hospital records.

Turmeric supplementation for 21 days resulted in clinically relevant and statistically significant improvement in global health status, symptom scores (fatigue, nausea, vomiting, pain, appetite loss, insomnia), and haematological parameters.

The authors concluded that turmeric supplementation improved QoL, brought about symptom palliation and increased hematological parameters in breast cancer patients.

Really?

The way the conclusions are phrased, they clearly imply that turmeric caused the observed outcomes. How certain can we be that this is true?

On a scale of 0 -10, I would say 0.

Why?

Because there are important other determinants of the outcomes:

  • placebo,
  • concommittant treatments,
  • natural history,
  • etc., etc.

Why does this matter?

  • Because such unwarranted conclusions mislead patients, healthcare professionals and carers.
  • Because such bad science gives a bad name to clinical research.
  • Because this type of nonsense might deter meaningful research into a promising subject.
  • Because no ‘scientific’ journal should be permitted to publish such nonsense.
  • Because it is unethical of ‘scientists’ to make false claims.

But maybe the Indian authors are just a few well-meaning and naive practitioners who merely were doing their unexperienced best? Sadly not! The authors of this paper give the following affiliations:

  • Clinical Pharmacology, Pfizer Healthcare Private Limited, Chennai, Tamil Nadu, India.
  • Department of Radiation Oncology, Faculty of Medicine, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India.
  • Process Development, HCL Technologies, Chennai, Tamil Nadu, India.
  • Department of Pharmacognosy, Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India.

Yes, they really should know better!

So-called alternative medicine (SCAM) is, as we all know, an umbrella term. Under this umbrella, we find hundreds of different modalities that have little in common with each other. Here I often focus on:

  • homeopathy,
  • chiropractic,
  • acupuncture,
  • herbal medicine.

There are uncounted others, and in my recent book, I published critical evaluations 150 of them. But for the moment, let’s keep to the 4 SCAMs listed above.

What strikes me regularly is that many SCAM enthusiasts do seem to appreciate my critical assessments of SCAM; for instance:

  • When I point out that the assumptions of homeopathy fly in the face of science, most SCAM enthusiasts agree.
  • When I point out that chiropractic spinal manipulations might not be safe, most SCAM enthusiasts agree.
  • When I point out that acupuncture is not a panacea, most SCAM enthusiasts agree.
  • When I point out that herbal remedies can interact with prescribed drugs, most SCAM enthusiasts agree.

Most but not all!

  • Those who find my criticism of homeopathy unfair are the homeopaths and their proponents.
  • Those who find my criticism of chiropractic unfair are the chiropractors and their proponents.
  • Those who find my criticism of acupuncture unfair are the acupuncturists and their proponents.
  • Those who find my criticism of herbal medicine unfair are the herbalists and their proponents.

Hardly ever does a herbalist defend homeopathy’s weird assumptions; rarely does an acupuncturist tell me that I am too harsh with the chiropractors; never have I heard a chiropractor complain that my criticism of acupuncture is unjustified.

Entirely obvious?

Perhaps!

But I find it nevertheless curious, because my critical stance is always the same. I do not change it for this or that form of SCAM (I would also not change it for conventional medicine, but I leave it to those who have more specific expertise to do the criticising). I have no axe to grind against any particular SCAM. All I do is point out flaws in their logic, limitations in their studies, gaps in the evidence. All I do is provide my honest interpretation of the evidence.

It really seems to me that everyone appreciates my honesty, until I start being honest with them.

And this is why I find it curious. Homeopaths, chiropractors, acupuncturists, herbalists and all the other types of SCAM practitioners like to be seen on the side of science, evidence, critical thinking and progress. This, I suppose, is good for the (self) image; it might even help the delusion that they are all evidence-based. But as soon as someone applies science, evidence, critical thinking and progress to their very own little niche within SCAM, they stop liking it and start aggressing the critic.

I suppose this is entirely obvious as well?

Perhaps!

But it also exposes the double standard that is so deeply ingrained in SCAM.

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