Not just old wives' tales

Not just old wives' tales Research shows there may be truth in what your mother's always said -- some plants are good for you BY JENNY NG WHEN PROF Dr Suhaila Mohamed was growing up, her mother told her about the medicinal properties of a common local plant, pegaga, or centella asiatica. She was sceptical but chose to study the plant in her research years later. "I was looking for a plant to research on, something that would be appropriate for Malaysia. I looked at local plants, and zeroed in on plants consumed based on traditional beliefs," says the professor of food science at Universiti Putra Malaysia. Six years into her research, which included testing the efficacy of pegaga on rats, she is convinced her mother was right. Suhaila's lab tests show pegaga contains diuretic and weightreducing properties and aids in protecting the eyes, lungs, kidneys and heart. Now, Suhaila takes daily doses of dried pegaga in capsules as a weight-management supplement. She is not alone in turning to traditional medicine. According to the World Health Organization (WHO), up to 80% of people in the developing south use traditional medicine as part of primary healthcare, and it is becoming popular in industrialised countries, where it is used in preventive and palliative care. The WHO defines traditional medicine as "health practices, approaches, knowledge and beliefs that incorporate plant, animal and mineral-based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well being". In industrialised countries, adaptations of traditional medicine are known as complementary or alternative medicine (CAM). The WHO says that in France, 75% of the population has used complementary medicine at least once and in Germany, 77% of pain clinics provide acupuncture. In the UK, expenditure on CAM stands at US$2.3 billion per year. According to WHO figures in 2002, globally, the market for traditional therapies stood at US$60 billion, and the figure is growing. Along with acupuncture, ayurvedic medicine and yoga have also become popular. The growing acceptance of traditional, complementary and alternative medicine (TCAM) in the West is partly attributable to the assimilation of immigrant communities with their cultures and traditional cures and therapies into Western societies, Dr Padma Venkat tells theSun. A joint director of the Foundation for Revitalisation of Local Health Traditions, a Bangalore-based, non-governmental organisation that focuses on revitalising Indian medicinal heritage, Padma was one of the speakers at the first international Women's Health and Asian Traditional (WHAT) Medicine conference held in late August in Kuala Lumpur. Another reason for complementary medicine's popularity is a growing awareness of the side effects of long-term use of pharmaceutical drugs. Some turn to traditional medicine to avoid invasive and costly surgeries where success is sometimes not guaranteed, adds Padma. Yoga therapist Florence Thomas can vouch for that. In July, she fractured and badly dislocated her right arm after a fall, and specialists initially suggested immediate surgery. The downside of surgery was it would take at least a year before she regained full use of her arm, and she would not be able to raise and straighten her arm over her head even after that. "I decided to seek other options. I went for ayurvedic massages using herbal oil and hot-salt treatment. As a trained yoga therapist, I practised certain yoga postures and relied on my diet," says Thomas, who has been practising and teaching yoga for more than 30 years. Six weeks after the accident, she removed her arm sling and her last X-ray shows the fracture had healed. A recent visit to the specialist confirmed no surgery was necessary, she says. Thomas' case highlights an interesting fact -- women are twice as likely as men to use complementary or alternative medicine. Professor Gerard Bodeker of Oxford University told the WHAT medicine conference that in developing societies in which traditional medicine is the primary healthcare, health knowledge has been passed down through the generations from grandmothers to mothers and daughters, making women the purveyors of traditional health knowledge. In the West, women have also emerged as early adopters of CAM. In 2002, a Women's Health Initiative study to evaluate the use of hormone replacement therapy (HRT) for disease prevention was halted due to increased risks of breast cancer, heart disease and stroke in long-term users. Since then, more women have turned to traditional medicine to manage menopausal symptoms. Although some scientists have said the findings have been misinterpreted, doubts have been cast on HRT, once hailed as the wonder cure for menopausal symptoms. According to Dr Ong Hean Choon, the former president of the Malaysian Menopause Society, about 30% of post-menopausal Malaysian women complain of menopausal symptoms but over 80% of these women do not seek treatment at all. Of those who do, 80% receive some form of treatment but 43% do not comply with the treatment prescribed. A 1994 study found that 41% of women who seek treatment for menopausal symptoms take herbal remedies, compared with 31% on HRT. Ong said in his presentation at the WHAT medicine conference that Malaysian post-menopausal women frequently resort to vitamins, calcium and evening primrose oil, although the last does not offer much value in the treatment of postmenopausal symptoms. Following the HRT controversy, other herbal substitutes like red clover, black cohosh and soy isoflavone supplements entered the picture. Herbal remedies such as dong quai and Chinese ginseng have always been taken by Malaysian women for menopausal flushes and to relieve fatigue. Other preparations taken include Bor age Plus, Ginkgo biloba, sea salmon oil, ginkgo phytosome and wild yam extract. But the decision whether to go on HRT or alternative remedy is ultimately a personal choice, says Dr Ravi Chandran, president of the Obstetrical and Gynaecological Society of Malaysia. Risks The popularity of traditional and complementary medicine aside, its misuse poses risks to users. For one, some herbs have interactive reactions with pharmaceutical drugs. For example, St John's wort, taken as an anti-depressant, affects the way the body processes certain drugs. Ginseng has blood-thinning effects and should not be taken with other anti-coagulant drugs. The field needs to be regulated but the sharing of information between modern medical doctors and practitioners of complementary medicine is also necessary. Bodeker says in the UK, for example, all medical schools are required to conduct an introductory course on complementary medicine. "Instead of self-medicating, consult reputable and qualified practitioners of traditional medicine," he advises. The lack of regulations and strict enforcement, coupled with the absence of evidencebased research, have led to some manufacturers of traditional medicinal products making wild claims about their products to enhance sales, or adulterating traditional products with steroids to enhance their effectiveness. "It is a quality-control issue. What you need is good quality control and once it's what it is supposed to be, it is less likely to have side effects," says Prof Fredi Kronenberg, director of the Rosenthal Centre for Complementary and Alternative Medicine at Columbia University, New York. In Malaysia, registration of traditional medicines has been enforced since 1992 under the Control of Drugs and Cosmetics Regulations 1984. The registration process involves preliminary screening of applications, testing of samples and evaluation of product documents. In fact, Minister of Health Datuk Dr Chua Soi Lek announced in August that the drafting of the Traditional and Complementary Medicine Bill 2006 is close to completion. The legislation is to regulate practitioners of traditional medicine in the country. Currently, close to 7,000 traditional practitioners have registered with the ministry. It's easy to see why -- herbal medicine registered annual sales exceeding RM4.5 billion since 2001 and the industry expects it to double by 2010. Chua also announced that three government hospitals -- Putrajaya Hospital, Kepala Batas Hospital and Pandan Hospital in Johor Bahru -- would be offering traditional treatment under the Ninth Malaysia Plan. But the combination of modern, traditional and complementary medicine is not something new. Bodeker estimates 95.5% of those using traditional and complementary medicine also rely on modern medicine. For instance, yoga therapist Thomas attributes her speedy recovery to yoga techniques and ayurvedic medicine but without X-rays, she wouldn't have known where and how bad the fracture was. "Someone involved in a car accident may not want a herbalist tending to him in the emergency room. However, in the rehabilitation process, he may want acupuncture treatment. There is a great role for modern medicine in managing acute conditions or trauma but for long-term illnesses like arthritis and asthma, many resort to alternative medicine," says Bodeker. "Eastern and Western medicine are interrelated. You can't divorce them, you need both," says Thomas.