WCD2016 Special Feature: The push for natural medicine into mainstream clinical treatment
Our grandmothers had utilized herbal extracts to good effect, so why shouldn’t modern medicine?
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BY SYAMIL ZAHARI
The concept of ‘integrative medicine’ in Malaysia is not yet well-accepted, especially by the Western-educated local clinicians, laments Associate Professor Dr Latifah Saiful Yazan, head of Department of Biomedical Sciences at Universiti Putra Malaysia’s Faculty of Medicine and Health Sciences, in an exclusive interview with AMOR Media.
Integrated medicine involves co-opting the use of natural health products, such as herbal supplements, alongside modern medicine in the clinical treatment of diseases such as cancer.
Dr Latifah’s various research on the development of new agents with chemopreventive and cancer-curing activities have won grants from organizations such as MAKNA (National Cancer Council of Malaysia) in 2007 and 2004, the L’OREAL Malaysian For Women In Science Fellowships in 2006, the Fundamental Research Grant Scheme (FRGS) in 2006 and Toray Science Foundation in 2004.
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Her research had discovered anti-tumour properties of Dillenia suffruticosa (Simpoh Air), Adisia crispa (Coral Berry) root, Christia vespertilionis (Red Butterfly Wing), Lactobacillus plantarum UL4 (Lactic acid bacteria) isolated from fermented tapioca, and many other local plants and grubs ranging from the common to the exotic.
For her effort in promoting natural medicines, Dr Latifah and her work were featured in Malaysian media such as The Star, Utusan Malaysia, Sinar Harian and Harian Metro.
Yet, the entrenched preconception of hospitals and clinicians against natural medicines is a hurdle still tenuous to overcome, according to Dr Latifah.
“Most of the time, medical doctors are not that open to natural products. They’d insist on a single entity [medicine], so that it would be easier to troubleshoot if anything happens,” she explained.
“Which is understandable,” she readily acknowledged, “but at the same time we cannot be so biased against herbal medicines.”
Falling behind
Dr Latifah recalled leading a talk where she set forth one of the justifications of using herbal supplements: their minimal toxic effects. “They are not without toxicity,” she emphasized, “but with minimized effects.”
A surgeon in her audience brushed off her argument and advised Dr Latifah “to wait until clinical trial,” she said with frustration.
Ironically, the problem with reaching clinical trials is the very narrow-mindedness towards natural medicine that inhibits researchers from receiving adequate share of funding money for research work, as well as establishing high-end facilities with advanced screening equipment and skilled chemists, Dr Latifah told AMOR.
“We are encouraged to do quality research; however, to do quality research, we’d need quality facilities. Yet, we cannot afford to buy equipment that we want in our labs,” she argued.
Frequent equipment breakdowns, delay in repairs and shortage of pharmacokinetics specialists are among factors hampering the researchers’ work, according to Dr Latifah. In addition, the less-than-sophisticated facilities are simply incapable of handling large volumes of screening or at speedier pace.
For instance, an entire process from identifying plants and proceeding to the trial stage and bringing the extracts to clinical trials, according to Dr Latifah, “would take 10 years to settle the pre-clinical and the isolation, if we’re lucky enough.”
This stands in contrast with the proficiency of facilities utilized by her fellow natural product researchers in other countries, she contended.
“The screening of potential anti-cancer agents from natural products is already being conducted in the US, where they have National Cancer Institute, with the setup that can screen thousands of extracts a day,” she said.
That is a very high throughput screening, Dr Latifah underscored. “But here, what’s the most we could do, per year? I would say, 20?” Dr Latifah rued.
“And remember, Malaysia is already so rich in bio-resources that even people outside could see the potential.”
World standard
Yet, justifiably, part of the medical field’s bias against natural medicines has to do with the deficiency of standards in ensuring products’ effectiveness, with no guarantee that every batch of plants collected would have consistent expected activity, Dr Latifah noted.
“To tackle the problem of [herbal products] not being able to troubleshoot later on, there is a need to develop a standardization to make sure that the efficacy exists and the toxicity can be predicted,” she said.
Fortunately, according to her, the Malaysian government is finally stepping in to address the standardization issue, in acknowledgment of the natural products industry’s commercial value, as part of a comprehensive agenda to transform Malaysia into a high-income nation by 2020.
The agenda “looks at improving the product quality and marketing efforts of dietary and herbal supplements to tap the global demand for high-value herbal supplements and remedies,” as well as “marketing and branding of nutraceuticals and botanical drugs with scientifically-backed claims, ensuring Malaysian herbal products comply with international health standards,” according to the Economic Transformation Programme (ETP) launched in 2010.
Additionally, the authorities understood “the potential of natural products in management of diseases,” Dr Latifah said, “and that’s the reason the Government incorporated natural product industry in its NKEA [National Key Economic Areas] – to generate income for the country.”
According to ETP, the estimated a gross national income (GNI) from high-value herbal products stands to reach RM2.21 billion (US$530m) by 2020.
Notion of the whole
Furthermore, while standardization ensures consistency of herbal products’ efficacy and predicted toxicity, it also upholds the research field’s distinct emphasis of investigating a plant’s entire properties, “so that we can develop a product, not as single entity, but as an extract as a whole,” explained Dr Latifah.
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Dr Latifah: “A herb is just a herb. We can reduce the cost by a lot.”
The concept of ‘the whole’ is why the development of natural products is worth pursuing due to the advantages of lesser cost and side effects.
“If you talk to herbalists, they will say that it is ‘the whole’ that will work,” she furthered, “because we believe a plant has both toxic and good compounds that work together.”
“If you were to develop a product – say, for cancer – then of course you’d want it to be cheap, so that everyone has the chance to get access to the medication,” she said. “Ideally, we’d want a drug that is cheaper and also with lesser side effects.”
“But that is not easy to achieve,” she continued. Drugs have to go through a lot of steps in their development, according to Dr Latifah. “In general, you may need 20 years for a plant to be developed into a drug. You can imagine how much money is needed in the 20 years,” she argued.
Meanwhile, “A herb is just a herb. We can reduce the cost by a lot,” Dr Latifah said.
“In my area of natural products, if we could identify one herb that has potential to help patients, the cost would be much cheaper compared to modern medicine.”
The curative potentials are already evident throughout human history. After all, ancient civilizations had found plant’s medicinal uses from as early as 3000 BC, “and herbal medicines have been used for so long by our own great-great-great grandparents,” she said.
Alternative management
Nevertheless, Dr Latifah acknowledged that the effort remains challenging and demanding. The future, however, looks increasingly favorable.
The World Health Organization estimated that 80% of people globally rely on herbal medicines for some part of their primary health care. In Germany, for instance, 600-700 plant-based medicines are available and are prescribed by some 70% of German physicians.
In some European countries, herbs are already classified as drugs and are therefore regulated, and the studies of herbalism and alternative medicine have entered the curriculum of more than half of medical schools and pharmacy schools worldwide.
All these indicate a global shift of patients and clinicians seeking a more homeopathic approach to treat ailments, partly due to “dissatisfaction with the cost of prescription medications, combined with an interest in returning to natural or organic remedies,” reported University of Maryland Medical Center.
As more global improvements in the analysis and quality control of natural medicines are introduced, according to Dr Latifah, in addition to greater advances in clinical research revealing substantial values of natural extracts in treating and preventing disease, “It gives some hope of developing natural products to become supplements accepted in hospitals,” she concluded with optimism.
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