10 Sep Op-Ed: Can indigenous Medicine cure Covid-19?

Making Indigenous Medicine available for all

If you have been hooked to Coronavirus news during last couple of months, you might have come across news titled “හෙල වෙදකම්න් කෙරෝනා වෛරසයටත් ව්සදුමක්” or “Doctors treating Covid-19 patients use traditional medicine for treatments”. Similarly, when the number of Dengue cases start rising, we start hearing about treatments based on indigenous medicine for Dengue. Even for chronic illnesses there are many indigenous medicine practitioners throughout the country who claim to have cures. Depending on your ideological bias, an article or a claim like this can evoke a range of emotions with one extreme being “all this is pseudoscience” and the other extreme being, “look, our ancestors knew how to treat all these illnesses”.  These two responses stem from placing our trust on two schools of thoughts; one being based on the scientific method (or more specifically modern medicine)  and the later being based on our indigenous medicinal practices. Given this disparity, if we ask the question “Can indigenous medicine treat illness X?” from experts from both sides, we get answers that are polar opposite. In any community it is normal to have such disparities in opinion. But the issue here is that we don’t have a proper working mechanism at national level to verify any of these claims. As a result, many fraudsters get the chance to fool thousands of helpless patients. At the same time the drug/treatment that actually works does not get the recognition it deserves and hundreds of patients lose an opportunity to get treatments.

Before discussing answers to the issue, we first need to understand why we need to pay attention to our indigenous medical practises when we already have a well established modern medical system in the country. Modern medicine (and science in general) never claims that it has all the answers. Instead, it continuously updates the knowledge base by following the scientific method (see Fig. 1).  Even though some people enjoy pointing this out as a weakness, this is the greatest strength and the reason behind the tremendous success in modern medicine  and science in general. This means, there is plenty of room for us as well to contribute to the scientific knowledge base. This is where the indigenous medicine comes in to the picture. Many countries around the world have successfully used the knowledge from their indigenious medicine to identify medicinal herbs with potential value and have developed various pharmaceutical products using them. For instance, Mayapple, a plant found in North America was used by the Native Americans as an herb. Because of this, it was studied during the 19th century to evaluate its medicinal value. Now the active ingredients found in it is used to develop certain FDA approved chemotherapy drugs[1]. Another example is the Red Yeast Rice from China. Chinese people have used Red Yeast Rice as a traditional medicine to treat cardiovascular issues that arise due to Cholesterol. Now, the extract from Red Yeast Rice is an FDA approved drug and is used to treat certain cardiovascular conditions [2]. Similarly, we can find many more examples. Just like those scientists had faith in their ancestors, we should also have a bit more faith in ours. They have lived on this island for tens of thousands of years and have accumulated knowledge over many generations. It would be naive to not study them properly.

Fortunately, we already have scientists studying our indiginous medicine practises. For instance, University of Colombo has the Institute of Indiginous Medicine (IIM) which was established in 1929 [3]. They publish the “Sri Lanka Journal of Indigenous Medicine (SLJIM)”[4] reporting their research findings. We also have the “Institute of Ayurveda and Alternative Medicine”[5]. They also report similar research on indigenous medicine in Sri Lanka apart from their main focus on Ayurvedic medicine.  It is also important to not forget about the Ministry of Health and Indigenous Medical Services[6]. Unfortunately, the page dedicated to Indigenous medicine only has “welcome” as text[7] and we think it clearly reflects their interest in Indigenous medicine.

So far, we have discussed why we need to pay attention to indigenous medicine and the institutes in Sri Lanka that are responsible for doing that. Now we look at what needs to be done to bring indigenous medicine knowledge into the mainstream. As mentioned before, to this, we need to follow the scientific method. First we need to gather information about indigenous medicines and practices. This include creating catalogs of different types of herbs and detailed reports on how they are prepared and used. When we look at the research work carried out by IIM, we can find many articles that belong to this category.

The next step is planning laboratory experiments and clinical trials to verify the claims. The objective of the clinical trials is to prove the safety and the efficacy of the treatment/drug. The clinical trials need to be randomized double-blind placebo-controlled. This means, neither the patient nor the doctor knows whether the patient is getting the experimented drug or a placebo drug (sugar pill). This is to remove the bias due to the Placebo effect. Normally these trials would be conducted in three phases. In phase I, the safety of the drug is validated. For this, only a small group of people are used. In phase II, efficacy of the drug is demonstrated and in phase III, both the safety and the efficacy of the drug is proven with a larger group of people. Any modern day medicine goes through this procedure. For instance, all the Covid-19 vaccines are following the same guidelines and at different stages in these clinical trials [8]. The laboratory experiments are to identify active ingredients and underlying mechanisms in these medicines. This helps us to understand how they work.

For clinical trials, the medicine can be used as in traditional practise. But when we want to bring it to the masses, methods need to be developed for mass production. Given that most of these medicines come from plants, producing the medicine in large quantities can be challenging. Alternatively, we can identify the active ingredients in the herbs and try to synthesize them using chemical processes. But this does not always become successful. In that case, one possibility is to look into sustainable farming of the plant.

Finally, the government has to properly regularize these procedures. They should promote the use of approved medicine and also ban ineffective medicine. Enforcing such a ban would not be easy. But once we have this mechanism in-place, laws can be introduced to verify the claims and reduce the number of patients who become victims to fraudsters.

It’s also important to be aware about the challenges when enacting a policy like this.  There can be strong opposition from both sides. Both parties have strong negative opinions about each other and would not be willing to participate in a platform that promote collaboration. It would be the duty of the government to find ways to bring these two communities together.  If successful, that along can be considered as a great achievement. Another challenge would be the painstaking search for drugs that work. This is expected in any scientific exploration. There can be hundreds if not thousands of remedies that do not work before you find one that actually does.

In conclusion, there will be many hurdles to overcome before we start hearing success stories. But, it is a risk worth taking because, if we succeed, new treatments will be found, at least some of the fraudsters will be identified and can also be a new source of foreign income.

Sources:

[1] Zheljazkov, Valtcho D., Jones, Andrew M., Avula, Bharathi, Maddox, Victor, Rowe, Dennis E. Lignan and Nutrient Concentrations in American Mayapple (Podophyllum peltatum L.) in the Eastern United States. HortScience, 2009; 44: 349-353

[2] Sungthong, B., Yoothaekool, C., Promphamorn, S. et al. Efficacy of red yeast rice extract on myocardial infarction patients with borderline hypercholesterolemia: A meta-analysis of randomized controlled trials. Sci Rep 10, 2769 (2020). https://doi.org/10.1038/s41598-020-59796-5

[3] Sri Lanka Journal of Indigenous Medicine (SLJIM). https://iim.cmb.ac.lk

[4] https://iim.cmb.ac.lk/sri-lanka-journal-of-indigenous-medicine-sljim/

[5] http://www.instituteofayurveda.org/english/research.htm

[6]http://www.health.gov.lk/moh_final/english/

[7]http://www.indigenousmedimini.gov.lk/

[8]https://www.theguardian.com/world/ng-interactive/2020/aug/08/covid-vaccine-tracker-when-will-we-have-a-coronavirus-vaccine

[9] https://cisncancer.org/research/how_cancer_is_studied/background/scientific_method.html