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Charlie Woo TV

Some of us received the announcement a week ago of the Bravewell Collaborative’s planned conference on “Integrative Medicine” co-sponsored with the National Academies’ Institute of Medicine, to take place in February, 2009.  (Note: I like to cap slogans and commercial trademarks and such and enclose them in quotation marks. Especially when the terms have no consensus meaning or are intended to obscure and confuse. ) 

Several of us may blog on the announcement. I want to emphasize a few points that struck me as revealing.  

The announcement also listed Friday’s Charlie Rose Pub TV interview program with Harvey Fineberg, MD, President of the “IOM,” Christy Mack, wife of the CEO of Morgan Stanley and the ideologue behind Bravewell and the project, and Ralph Snyderman, ubiquitous former dean of Duke University Medical School now vagabond “CAM” promoter and fund raiser. 

First off was a significant disclosure. Charlie Rose had been married at one time to Christy Mack’s sister, and Christy and he were still dear friends. As if disclosure is enough to help a viewer distinguish between facts and views obscured by a haze of politeness, appreciation, and gooey mutual stroking.

So much for  investigative, penetrating, and revealing journalism.

Snyderman, whose school was recipient also of large Templeton Foundation grants to ivestigate significance of spirituality and religion in “healing” revealed that he at one time was one of those straight arrow physicians who treated disease (instead of a person.) Until he experienced some of “the techniques” – unspecified – himself. In typical testimonial phrasing, he found it wondrous that something as intangible as hope could help heal. (Some of us also find that wondrous – even dubiousl.)  And then the tried and trite criticisms of docs being too involved in details (like what works and how to use it) and losing sight of the “whole person.”  ”Health is a value and one can have impact…” Eyes roll at such platitudinous and vacuous language.

If that were not enough, Fineberg demonstrated his deep knowledge of “Integrative Medicine” by telling the difference between “healing” and “curing,” and his democratic outlook by wanting to test any methods that works – regardless of the origin. David G’s blog the other day and Kim Atwood’s previous words discussed that issue, which still befuddles the NCCAM, which seems to test anything whether it contains molecules or not, and whether the idea generated in a crucible of observation and experimentation, or descended in a 2 AM drug-induced revelation.  He then used artemisinin (for resistant malaria) to illustrate the potential mining of miraculous natural drugs from traditional Chinese Medicine. I assume he assumed that TCM practitioners had  had been using it for malaria for centuries…despite the fact that there was no description of infectious diseases in TCM. Finding artemisinin for malaria was a product of extraction and purification from plants, known as modern pharmacology.

Christy Mack tried to introduce new concepts, explaining that one of her new aims is to empower the patient to heal oneself…That is not only decades old, but a word-linkage that, as with all esoteric ideation , means a lot to her and her co-believers, but little to the uninitiated.  Another concept was for each person to make a personal health plan for one’s life.  Can’t I do that now if I want? Seems I already did, then chance and nature intervened…

When Snyderman let slip the term, “CAM”, Mack jumped in saying, “Integrative Medicine” is not “CAM”.  Here was a clue to the joining of these otherwise poorly fitting edges of “IM” and the “IOM.”   We just won’t talk about those inconvenient absurdities that “IOM” might shrink from. My take is that Mack and ”CAM” advocacates want the blessings of as many System organizations as possible to fill their “CAM” CV as prelude to legitimization, licensing, and insurance reimbursement.  “CAM” practitioners are using the Bravewell as internediary to using “IOM.” Morgan Stanley money being an efficient lubricant. Simple.

So “IOM,” in exchange for more $?millions as it did for the NCCAM committee, sells itself and its merit badge for ”CAM”‘s  CV sash.  Fair exchange in this capitalist system, yes?  Seems that the only factor nissing in this exchange that keeps it from illegality is a sexual act. The Quiet Revolution moves on. 

Personal note: In 1993 when I awoke from 3 weeks of post-op unconsciousness in the ICU, the first things I recalled were on the overhead TV: the NCAA basketball finals, the Waco cult building complex on fire, and Charlie Rose interviewing another talking head with that ominous blacked-out background. The Quiet Revolution moves on as the Nightmare recurs. �

Posted in: Faith Healing & Spirituality, Health Fraud, Medical Academia, Science and Medicine, Science and the Media

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39 thoughts on “Charlie Woo TV

  1. Thank you, Wally. I was hoping someone had seen the Charlie Rose interview and would report on it. I hadn’t imagined that the report would be presented with such exquisite, if depressing, irony.

    One of the subtexts, if you’ll excuse the PoMo term, of the IMC movement (oh yeah: that stands for “implausible medical claims”) is an obsession with one’s “health.” Look at the cover of any Women’s Magazine (and the occasional Men’s) over the last couple of decades and you see little else, other than how to make marriage fun again. Funny: those most obsessed with “wellness” tend to be those with the least to worry about. A topic for a whole blog or a whole book.

  2. David Gorski says:

    It’s probably a good thing that I didn’t watch the show. It would have raised my blood pressure almost as much as watching former Playboy Playmate Jenny McCarthy on Larry King’s show rambling on about how vaccines cause autism and how she “cured” her son Evan of his autism through diet.

    Maybe more, because few take McCarthy seriously (and rightly so–she’s an idiot), while the Bravewell Consortium is a serious force for promoting woo over scientific medicine.

  3. apteryx says:

    Of course, the ancient Chinese had no germ theory of disease – not surprisingly, as they didn’t have microscopes – and their mystical explanations for observed disease patterns (imbalances of chi, heat and cold, humors, etc.) do not make biological sense. That doesn’t mean that they did not suffer from diseases as we currently define them, that they did not recognize those different patterns of symptoms as distinct entities, or that they did not treat those conditions. No, they didn’t call Plasmodium infection “malaria,” and they didn’t attribute it to infection of the blood by invisible parasites, but they most certainly were familiar with the illness and treated it with artemisia.

    Modern pharmacology (or pharmacognosy in the modern sense of the word) extracted the most potent active compound and made an even better drug of it. That’s real progress, for those who can afford the drug. But let’s not try to pretend that this was not based on traditional knowledge. The researchers did not screen all twenty or thirty thousand Chinese plant species; they studied artemisia precisely because of its traditional use for febrile illness. Giving partial credit for initial observations of nature to healers who were pre-20th century or from a nonwhite culture does not detract from the achievements of pharmacology. Denying credit that is obviously justified looks like insecurity.

  4. Joe says:

    Apteryx wrote “The researchers did not screen all twenty or thirty thousand Chinese plant species; they studied artemisia precisely because of its traditional use for febrile illness.”

    True; but they screened more than 100 plants that were used to treat malaria and only found one that was active:
    Brit J Clin Pharm 2006 artemisinin review
    http://www.ncbi.nlm.nih.gov/pubmed/16722826?ordinalpos=21&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    That’s not a good score for ethnobotany.

  5. weing says:

    Not all TCM works. I think there were about 200 traditional treatments for malaria. Artemisin was the only one found to be effective. Being a skeptical empiricist, I don’t care what the mechanism is and am willing to wait until an explanation is found. As long as I have proof something works, I can use it. TCM also had empiric treatments for stomach ulcers and the emperor was apparently prescribed semen for his. It worked fine due to the prostaglandin content. Another treatment was bear bile for gallstones. All these treatments were found sometime ago and medications were developed by isolating the active ingredients. The research was done by pharmaceutical companies and continues to be done in their never ending quest to make a profit by producing something we will buy that actually works.

  6. apteryx says:

    Do you mean that only one species had any in vitro antimalarial activity as a crude extract, or that only one was successfully made into a single-compound drug? You have claimed the former more than once, but that is extraordinarily unlikely given that other studies of indigenous treatments for malaria show far higher rates of activity – and even plants selected from a local pharmacopoeia at random, in one study, have several times higher rates of antimalarial activity. There is a difference between “being ideal raw material for a pharmaceutical” and “being active.” The abstract you link to makes no mention of numbers of species screened or with what results; it appears to be more of a historical paper. I don’t have a copy of the paper, but I’d bet a substantial amount that it is NOT the case that over 99% of traditional treatments for malaria had zero activity in vitro.

  7. Joe says:

    Apteryx, if you click on the link
    http://www.ncbi.nlm.nih.gov/pubmed/16722826?ordinalpos=21&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
    there is a link to the free text on the upper right.

    There was a recent UK documentary on artemisinin that claimed more than 200 plants were examined; I assume that includes more studies than the massive campaign reported in the review I cited.

    Apteryx wrote “… other studies of indigenous treatments for malaria show far higher rates of activity …” Perhaps you could cite some of those studies.

  8. apteryx says:

    Thanks for your willingness to direct me to the free text, Joe. I had not seen that link. The relevant sentence in the paper is a quotation from a Chinese official document, as follows:

    “From July 1971 onwards, we screened more than one hundred single drugs and composite prescriptions of the Chinese herbal arsenal, and discovered qinghao (derived from plant material of the plant huanghuahao, i.e. Artemisia annua).”

    This can in no way be taken to mean that the other 100+ medicines screened had no activity. It means simply that Artemisia was the most potent plant screened, and therefore that it was their top choice to develop for use against malaria. Incidentally, the paper also notes the following:

    “Qinghao was among the first 10 items to be screened at the time, but no antimalarial properties were found, because the most active antimalarial substance in the plant extract, artemisinin, is soluble in neither water nor ether. Only 2–3 years later, after various abortive attempts in the laboratory, some brief spells in the field and a variety of projects with several collaborators, did Professor Tu Youyou and her research group develop an extraction method that proved successful.”

    I’d offer two thoughts about this. First, it is lucky for a lot of people that those original negative results were not met with the attitude of “Of course it doesn’t work, what could stupid nonscientist primitives have known? Time to end all further research on this plant that has been proven worthless.” Second, might some of the plants that appeared weaker in the broad screening program not contain similarly undetected value?

    I don’t have a lot of ethnopharmacological literature to hand, but can cite: W. H. Lewis. Pharmaceutical discoveries based on ethnomedicinal plants: 1985 to 2000 and beyond. Economic Botany 2203; 57:126-134. This paper compares the Aguaruna people’s 14 best antimalarial botanicals with 14 randomly selected botanicals from their pharmacopoeia. At 20 ug/ml, extracts from the antimalarial species showed average 83% inhibition of Plasmodium falciparum (range: 51%-98%), whereas extracts from the random species showed average 55% inhibition (range: 3%-98%). By contrast, the Aguaruna had few recommended botanicals for TB and randomly selected medicinal plants versus plants chosen by family had similar average anti-TB activity. Since TB was introduced only recently, the Aguaruna have little experience with treating it, whereas they have had to survive malaria for millennia (as did, for example, the Peruvian natives who discovered quinine).

  9. apteryx says:

    Okay, here is more from PubMed.

    http://www.ncbi.nlm.nih.gov/pubmed/17572031?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    [4 of 5 Kenyan antimalarials showing activity at some level]

    http://www.ncbi.nlm.nih.gov/pubmed/17221829?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    [Of 8 Kenyan antimalarials, 3 showing strong activity, plus 4 showing moderate activity that was increased when they were combined with one of the other species, as is often done traditionally.]

    http://www.ncbi.nlm.nih.gov/pubmed/17145149?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    [Kenyan plants, but Japanese study; 7 of 15 had statistically significant reduction of parasitemia in mice, also with indications of possible synergy with chloroquine]

    http://www.ncbi.nlm.nih.gov/pubmed/17126508?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    [5 Malian plants screened, 4 antiplasmodial, the best at IC50 of 7 ug/ml]

    http://www.ncbi.nlm.nih.gov/pubmed/16517108?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    [Danish study of Peruvian plants; 11 of the 13 most frequently reported used for malaria had significant activity]

    http://www.ncbi.nlm.nih.gov/pubmed/16141673?ordinalpos=7&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    [Indonesia: of 22 plants, 8 had strong antimalarial activity (>89% inhibition) and 15 had strong antibabesial activity]

    http://www.ncbi.nlm.nih.gov/pubmed/15849870?ordinalpos=9&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    [French Guiana: 35 remedies tested; 4 popular preventatives >50% inhibition in vivo at 100 ug/ml; 5 with IC50 in vitro <10 mg/ul; two more active than Cinchona in one in vitro assay; one found to interfere with intrahepatic cycle.]

    http://www.ncbi.nlm.nih.gov/pubmed/11378289?ordinalpos=17&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    [3 of 14 Ghanaian plants used for "fever or malaria" had significant activity.]

    http://www.ncbi.nlm.nih.gov/pubmed/8203297?ordinalpos=21&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    [58 samples from 43 Tanzanian ethnomedically selected species, 13 provided directly by healers. 37% showed strong activity with IC50 under 10 ug/ml.]

    Other studies that screen “medicinal plants” but not specifically antimalarial plants tend to have a hit rate of a few to several percent, much lower than seen in these studies.

    I don’t suggest that traditional healers knew everything there was to know, or that their remedies can’t in many cases be improved upon by pharmaceutical science. But to insist that they are all worthless is simply unsupportable. Denigrating traditional knowledge provides the philosophical underpinning for biopiracy. It lets you use quinine or artemisinin when you get malaria, without having to give non-Westerners any credit. So what if the dumb savages prepared a worthless antimalarial remedy out of the same plant from which the wise pharmaceutical company extracted an effective antimalarial molecule? That’s obviously a coincidence, so we don’t have to compensate them for their “knowledge” (as they have none), even if it was their silly superstition that led us to screen the plant.

  10. Joe says:

    Apteryx wrote “This can in no way be taken to mean that the other 100+ medicines screened had no activity.”

    Yes it can. It takes wishful thinking to interpret it otherwise. Any product showing just 50% of the activity of artemisinin would have been equally interesting. “No activity” is a straw man, unusable activity is also useless.

    Apteryx wrote “I don’t have a lot of ethnopharmacological literature to hand …”

    Yet you feel free to make broad, unsupported claims. Where are all the articles that support you?

    Apteryx wrote “At 20 ug/ml, [of what?] extracts from the antimalarial species showed average 83% inhibition of Plasmodium falciparum (range: 51%-98%) …”

    Can you make that, particular, article available to us? And, why is something with 98% activity not available to us? Malaria is a HUGE problem, I cannot believe a useful treatment is sitting, idle.

  11. apteryx says:

    Joe,

    I posted a lengthy message with about ten PubMed citations and remarks on their content, but it was held for approval by the website. If this message goes through, let me just suggest that you go to PubMed and search “antimalarial plants screening.” You will get 34 hits. Note that many of them screen “medicinal plants” used by particular groups, without specifying that they are used for malaria; the hit rate in those studies is lower.

    Some folks around here shout “straw man” with such frequency that I wonder if they were traumatized by watching the Wizard of Oz as children. A dictionary will agree that “unusable activity is useless,” but activity that does not lend itself to drug development is not useless activity, if indigenous peoples are indeed using it to relieve the symptoms of endemic diseases. Further, nobody has infinite money to develop compounds from numerous plants simultaneously, so the fact that a plant has not yet produced a drug does not mean that it never will.

    I have only a hard copy of the Lewis article. You can look it up. The article does not name the individual plants or compounds that were the most potent. This was done to protect the Aguaruna’s intellectual property rights. If you want it to be available to you, you will have to deal with them respectfully, and agree upfront to pay them a large share of your royalties.

  12. Joe says:

    Apteryx, trust me- I know how to find information. It’s just that we have to be talking about the same articles to have a conversation. I look forward to your post with the PubMed cites.

    Apteryx wrote “… if indigenous peoples are indeed using it to relieve the symptoms of endemic diseases.”

    I think we have established that a lot of Chinese were, indeed, using inactive herbs to relieve symptoms … You need more support for efficacy than popularity.

    Apteryx wrote “The article does not name the individual plants or compounds …”

    Articles that do not include all data are not worth the paper they are printed on.

  13. Zetetic says:

    I wonder about the relationship between different racial groups and ethnopharmacological studies. Admittedly, DNA study reveals that the real differences between racial groups are miniscule but witness the apparent protection from malaria that sickle cell anemia offers to the black race. Is it possible that some traditional medicines work better along racial lines?

  14. apteryx says:

    Joe writes:

    “Articles that do not include all data are not worth the paper they are printed on.”

    You betray some ignorance here: that depends upon the purpose of the article. In ethnobotany, it is now common to avoid publication of detailed information that could be exploited by outsiders to the detriment of indigenous people’s interests or environment (e.g., as Hoodia has been exploited). Yes, if a plant is to be developed into a drug there will have to be publications that specify what compounds are involved. But before the research that leads to those publications can even begin, there needs to be a benefit-sharing agreement to protect the interests of the knowledge-holding group. If you refuse to admit that non-Westerners possess any knowledge, obviously you will not be concerned about whether it may be stolen from them.

    Joe writes:

    “you feel free to make broad, unsupported claims”

    along with:

    “Apteryx wrote “This can in no way be taken to mean that the other 100+ medicines screened had no activity.”

    “Yes it can. It takes wishful thinking to interpret it otherwise.”

    and:

    “I think we have established that a lot of Chinese were, indeed, using inactive herbs to relieve symptoms”

    You wish to tell yourself and others that over 100 herbs less potent or otherwise less practical for drug development than artemisia were shown to have no activity. But that would be a stunning surprise given the results from all other similar studies, and you have not presented a shred of evidence for the claim. The post with the PubMed citations was held up, I’m sure, because of the number of included links. But you can do the search and read the abstracts just as I did, if you like. Until then, my continuing to discuss this issue with you would be a waste of bandwidth.

  15. Joe says:

    Okay, Apteryx, I looked at some of your data-dump. Nothing showed clinical evidence. I assume that the rest was as feeble (if you had any good information, you would not precede it with nonsense).

    I think that we (you and I) have established that in vitro data does not translate to a drug (if you don’t get it, write that down and memorize it now).

    Apteryx wrote “But you can do the search and read the abstracts just as I did …”

    Yes, and I can UNDERSTAND them; you do not.

    Your discussion has been a waste of bandwidth from the start- why worry about that now?

  16. apteryx says:

    Goodness, Joe! This is why I have repeatedly sworn off arguing with you; you so readily resort to slurs and ad hominem attacks when the evidence is not in your favor. I have challenged specific instances of sloppy reasoning on your part, but I have not made nasty insinuations about your intellectual or rhetorical abilities at large. If the goal is to sway undecided readers, my strategy is better than yours; name-calling in any argument appears as an act of weakness.

    Yes indeed, screening assays are not clinical trials (you could hardly do a clinical trial to test 100 plants simultaneously, nor would any IRB approve clinical trials of 100 poorly known plants). Yes, most plant extracts that are antimalarial in vitro may never be found to contain perfect precursor molecules for the making of a patentable drug. The point to screening assays is that when people tell you a list of their local plants are antimalarial, and extracts of many of those plants actually suppress malaria in the available, affordable in vitro assays or rodent studies, that makes it harder to say “Stupid natives can’t possibly know anything.” Unless, I guess, you have an attitude like Joe’s.

  17. Joe says:

    Goodness, apteryx! You don’t understand why I am frustrated with your claim that there is a natural product showing 98% activity against malaria; but you cannot provide the data? Do you appreciate how important such a discovery would be?

    You say I am ignorant of ethnobotany. Yes, deliberately so. It is merely collecting anecdotes (which are not data). I have wondered how many proven, useful products are derived from the tens of thousands of claims of ethnobotany. Can you tell me?

    You quote “‘Stupid natives can’t possibly know anything.’” Yet you claim an aversion to “straw man” arguments. Nobody here has made such a statement. Look up the meaning of “irony” in your Funk ‘n Wagnel’s (dictionary).

    Yet, to be polite, I should note that your comments did elicit an excellent essay on “medicinal chemistry” by Steven Novella (as I recall). So, that is a positive influence on your part.

  18. Wallace Sampson says:

    thanks to Apteryx and Joe. Took the heat off me (Whew.)

    Comments: I have been blindsided by ethnobotanists after statements in a public place. In this case (artemisinin) it was a comment on a comment by IOM’s Dr. Fineberg, non-stating the unstated: that traditional uses are most often multiple, the disorders undefined and often mistaken, so that when an observation of effectiveness seems likely and is followed up, the denominators made of number of uses, number of observations plus (or times) the number of other plants in use for similar symptoms, and other multiples become lost in the ratio. What remains is the fraction expressing the one use that works out and the plant examined.
    Thus, when I was asked about artemisinin, then being investigated several years ago by a reported for a major journal. not only were those comments of my answer unreported, but only the denial in the form of, “it is a matter of chance that an effective material is found” got in. That led to several critical LTEs who correctly pointed out that the quote was misleading. But the writers also made an incorrect point that narrow minded skeptics won’t look at promising natural cures.
    Well, as a recovered oncologist who used many natual-soured compounds (vincas, antibiotics) I could only shake my head in frustration. I sold life saving therapy sometimes by telling people the materials were “natural” (!)
    The blindsiding comes because ethnobotanists and advocates know a hell of a lot more about plants and their historical uses than I do. And it takes me hours to check on sources for validity, interpretation, etc., until eyelids droop, or I drop it. They often win even if wrong.
    I dealt with the principles and observations of TCM herbalism in letter exchanges a year ago in Medscape General Medicine (now Medscape J Med.) The stuff may still be on line. I could not expound on TCM or herbalism at length originally because of 300 word limits.
    Same here but with the limit being time and memory – I did not tape the Charlie Rose session, so could be wrong on a few points.
    I appreciate the points you all make…instructive .

    WS

  19. apteryx says:

    Maybe you have also used the plant-derived drugs taxol or irinotecan? The latter ought to be instructive for people who aren’t interested in any plant that hasn’t already generated an approved drug. The crude extract of the camptotheca tree showed potent anticancer activity, but when the active compound, camptothecin, was isolated, it proved to be so toxic it could not be used for chemo (!). It sat around unused for twenty years until researchers elucidated its mechanism and figured out how to alter it to be less toxic. The moral of the story is that valuable precursor molecules are not always immediately obvious or rapidly exploitable. It may take decades of work to extract the potential from one natural compound – and that’s assuming that the research dollars, manpower, and interest are there. Hopefully, modern methods in pharmacognosy and pharmacology will make the development process faster and cheaper in the future.

  20. Apteryx, you said, “I don’t suggest that traditional healers knew everything there was to know, or that their remedies can’t in many cases be improved upon by pharmaceutical science.”

    Aside from cinchona, do you have hard evidence that traditional healers effectively and routinely treated malaria with artemisinin or any other botanical? I don’t mean evidence that they used it but rather evidence that “it worked”. A scientific reference would be best, of course, but if that is lacking, is there a reliable historical reference?

    If artemisinin were in fact such an obviously effective treatment for malaria, why would traditional chinese healers not stop using the hundreds of other ineffective remedies and only use it?

    While the answer to my questions may be obvious to drug scientists, they aren’t obvious to me, a lay person.

  21. Joe says:

    Apteryx wrote “Maybe you have also used the plant-derived drugs taxol or irinotecan?”

    I don’t believe Taxus sp. was historically used to treat cervical cancer, so that was not found through ethnobotany. In addition to the fact that the ancients didn’t know much about cancer, as far as I know, taxol is not orally bioavailable. Also, as far as I know, Camptotheca sp. was not used to treat cancer.

    If we stuck to ethnobotany, we would have missed those drugs.

  22. In order to answer the questions I asked above, I googled “artemisia”. Of the hits that came up, I clicked on wiki. Since I do not have the time to investigate every botanical drug for which drug claims are made, I will assume that the wiki statements, some of which I quote below, are accurate until someone, hopefully one who makes claims of benefits, presents reliable references showing that they are not.

    http://en.wikipedia.org/wiki/Artemisia_annua:

    “Artemisia annua…was used by Chinese herbalists in ancient times to treat fever, but had fallen out of common use, to be rediscovered in 1970 when the Chinese Handbook of Prescriptions for Emergency Treatments (340 AD) was found.”

    “It was one of many candidates then tested by Chinese scientists from a list of nearly 200 traditional Chinese medicines for treating malaria. It was the only one that was effective.”

    “In 1971, scientists demonstrated that the plant extracts had antimalarial activity in primate models, and in 1972 the active ingredient, artemisin (formerly referred to as arteannuin), was isolated and its chemical structure described.”

    http://en.wikipedia.org/wiki/Artemisinin:

    “Artemisinin and its derivatives are now standard components of malaria treatment in China, Vietnam, and some other countries in Asia and Africa, where they have proved to be safe and effective anti-malarial drugs.”

    “To counter the present shortage in leaves of Artemisia annua, researchers have been searching for a way to develop artemisinin artificially in the laboratory.”

    It also states that Artemisinin is not used alone but in combination with other anti-malaria drugs.

    From this I assume that unlike cinchona, the plant’s effectiveness in treating malaria was not obvious to traditional Chinese healers or their patients. I also assume that the reasons are the same as for other medicinal herbs. Mother Nature doesn’t standardize plants. The mix and amounts of ingredients in them vary greatly from plant to plant, season to season, location to location, time of harvest, etc. And then there is sometimes the problem of a shortage of plants which could be another reason why using a traditional remedy rather than a scientific drug would be impractical. I don’t know but would guess that in some places in the Third World people find it hard enough to grow enough plants to feed themselves without trying to also grow plants to make traditional remedies from.

  23. apteryx says:

    rjstan – Wikipedia authors don’t always know everything there is to know about foreign cultures! The plant is in the official Pharmacopoeia of the PRC and in many other Chinese herbal references. This idea that its use was abandoned for millennia and taken up again entirely de novo when some ancient volume was “rediscovered” makes no sense. I have seen the same claim pretty much verbatim elsewhere. It seems to be a distortion of the correct statement that its use was first recorded some two thousand years ago. That doesn’t mean it was never recorded since!

    There have been human clinical trials of crude artemisia, as well as animal studies, which show that it is effective as a treatment for malaria. It is less effective than high-dose artemisinin, but it was far better than nothing. Healers used it because it relieved people’s symptoms, and they were able to observe that. Again, the Wikipedia claim that the other [however many] tested plants were worthless keeps cropping up but never seems to have supporting details. Artemisinin derivatives, by the way, are used in combination with other drugs rather than separately not because they are ineffective alone – quite the opposite is true – but because world health authorities are trying to KEEP them effective by slowing the development of resistance, which is far more rapid when single-compound therapies are used.

    Traditionally, it has usually been more efficient to gather medicinal plants from the wild than to cultivate them. They grow in their native habitats without cultivation, of course, and they are needed only in small quantity. It certainly is possible for scarcity of valued medicinal plants to present problems. The Romans apparently drove a valued contraceptive plant to extinction. But remember that even today, a clinic and pharmacy may be days’ journey away and unaffordably expensive, so the plants of the nearby forest are still more accessible to people who, as you note, are often struggling just to feed themselves.

  24. Joe says:

    @rjstan, since you directed those questions to apteryx, I decided to wait.

    rjstan asked “Aside from cinchona, do you have hard evidence that traditional healers effectively and routinely treated malaria with artemisinin or any other botanical? I don’t mean evidence that they used it but rather evidence that “it worked”. A scientific reference would be best, of course, but if that is lacking, is there a reliable historical reference?”

    Apparently not.

    rjstan asked “If artemisinin [the ancients used the plant (Artemisia), not the drug] were in fact such an obviously effective treatment for malaria, why would traditional chinese healers not stop using the hundreds of other ineffective remedies and only use it?”

    Artemisia was not obviously effective- as you suggested in your second post, the plant does not always contain artemisinin (it may have also depended on how it was processed for administration). Furthermore, they did not adequately test products nor disseminate information in those days. You say that’s not enough? You say you want more? There was no specific diagnosis of malaria- Artemisia sp. could have been ineffectively used for superficially similar fevers.

    Also inre your second post, the reason the drug is used in combination with others is because malaria is developing a resistance to it.

  25. Joe says:

    Cross posted!

    apteryx wrote “Again, the Wikipedia claim that the other [however many] tested plants were worthless keeps cropping up but never seems to have supporting details.”

    That is an argument about semantics. The notion that other plants are effective is factually unsupported here.

    On the one hand you laud the identification of camptothecin as a lead to a derived, anticancer drug; then you argue (without any evidence) that we have overlooked the activity in 200 herbs that had been touted as antimalarials. Is this what is meant by cognitive dissonance.

    apteryx wrote “But remember that even today, a clinic and pharmacy may be days’ journey away and unaffordably expensive, so the plants of the nearby forest are still more accessible to people who, as you note, are often struggling just to feed themselves.”

    I certainly hope they are not wasting time and energy getting ineffective treatments. For example, it seems that South Africans are being told to use demonstrably ineffective (yet cheap and available) products (e.g., garlic) to treat AIDS.

  26. Apteryx, I know very well that wikepidia is not a reliable source and thought that I stated that. I said that I would assume it was accurate until someone presented a reliable reference showing that it was not. I am still waiting for such a reference, one showing that traditional Chinese healers effectively and routinely treated malaria with artemisia. I don’t mean evidence that they used it but rather evidence that “it worked”.

    Now please correct me if I’m wrong, but I understand you to say above that artemisia has been used continually for a very long time by CTHs, but you also say that artemisinin is used in combination with other drugs the WHO wants to prevent malaria from becoming resistant to it for as long as possible. If that is the case am I to conclude you are also saying that malaria did not become resistant to artemisia during the long period you claim it was effectively used or rather that the WHO fears are unfounded?

    Joe, the fact, if it is a fact, that CTHs used many other botanicals in addition to artemisia to treat fevers is important in my opinion because it indicates that based on their collective experiences they believed that those other botanicals either effectively treated other diseases that caused fever or else the healers did not notice that artemisia was effective in far more cases of fever than all the others put together. If that is the case, then I believe that they were not concluding based on their observations that artemisia worked very often, or in other words it didn’t stand out above the crowd which makes me think that its positive effects were for all the reasons you’ve stated too small to notice making it very plausible that the wiki statement about its having been forgotten is accurate.

    I realize that way back then no traditional healers, not even my own forefathers and mothers, kept good records or objectively tested their medicinal herbs. I also realize that the ancients were treating all fevers, not just those caused by malaria, with whatever as a result of trial and error and personal observation they believed might possibly work. However, if they as someone else has already stated, got one out of 200, their record is not good which is not a reflection on their intelligence or culture. Civilization had to crawl before it could walk. I just hope people have the good sense not to get down on all fours again. Somehow I don’t think that the ancients, my forebears and everyone else’s, would consider that wise.

  27. apteryx says:

    rjstan wrote:

    “Civilization had to crawl before it could walk. I just hope people have the good sense not to get down on all fours again.”

    I wonder if you have any idea how ethnocentric, if not worse, that sounds. Only your culture “walks upright?” And maybe only starting with your generation, since Western pharmacy in the early 20th century did not rely upon randomized controlled double-blind trials either? Your culture does possess more total information than either Chinese culture or previous generations of Western cultures. For you to assume that that means these cultures can have no information of value that yours doesn’t already have, and that information can and should flow only from yours to theirs, is simple arrogance.

    Regarding resistance: You are confusing single-compound drugs with multicomponent botanicals. Think of cinchona bark versus quinine. The Peruvian people used the bark successfully for centuries to treat malaria and (unwisely for the rest of the world) shared the secret with European invaders. The malaria in their area was, obviously, not resistant to it despite that history of use. (I am hoping here that you can acknowledge the efficacy of cinchona/quinine.) After the single molecule quinine was isolated and widely used, resistance began to develop relatively soon. This is because it is easier for a pathogen to evolve resistance to just one molecule at a time, than to several somewhat different molecules simultaneously.

  28. qetzal says:

    apteryx wrote:

    This is because it is easier for a pathogen to evolve resistance to just one molecule at a time, than to several somewhat different molecules simultaneously.

    This assumes that there are in fact several different molecules with antimalarial efficacy in the bark. Do you know this to be true?

    Even assuming you’re correct that no resistance developed to the bark, there are plenty of alternative explanations, including the differences in amount and breadth of usage.

    My point is this. Among proponents, there is often a tendency to claim (or at least imply) that herbal medicines are superior because they have many different components. You have done the same thing here. But I have never seen any evidence to back that up.

    Admittedly, I don’t pay close attention to the literature on this subject, so maybe I’m just ignorant of known examples. Can you provide any?

  29. apteryx says:

    Well, I have never seen anyone provide evidence for the common assertion that a plant will have only one active molecule, and I have never bothered asking if they can cough up evidence. All I can do, on these many things where I am not an expert, is search PubMed. Cinchona contains multiple “quinine alkaloids,” including cinchonine, cinchonidine, quinidine, and quinine. Here is a reference that mentions the alkaloids as a group as being antimalarial and discusses mechanisms.

    http://www.ncbi.nlm.nih.gov/pubmed/14505493?ordinalpos=9&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    Here is an in vitro study of P. falciparum in which quinine was the least potent of the four.

    http://www.ncbi.nlm.nih.gov/pubmed/15508779?ordinalpos=7&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    Here’s another study showing the same thing:

    http://www.ncbi.nlm.nih.gov/pubmed/2190002?ordinalpos=26&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    Quinidine may also be anti-trypanosomal:

    http://www.ncbi.nlm.nih.gov/pubmed/11582539?ordinalpos=14&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

  30. Joe says:

    apteryx wrote “I have never seen anyone provide evidence for the common assertion that a plant will have only one active molecule, and I have never bothered asking if they can cough up evidence.”

    Is that a common assertion? It has not been asserted here. Is your statement a Straw Man (you know, what you eschew)? I wrote that Artemisia sp. contain a half-dozen anti-Plasmodial compounds; but artemisinin is 1000 times more active than the next best. That does not mean that other components cannot have other, beneficial, activity. It also does not suggest that cinchona does not have other, active, components. In addition, think of Taxus sp.; as we have noted, it provides an anti-cancer drug that was unknown to historical use.

    Your arguments are based on what you wish we wrote (which you think you can refute), rather than what, in fact, we write. I don’t know if you realize how ethnocentrist that is … You are trying to tar us with your prejudice.

  31. apteryx says:

    I don’t feel that I need to comment regarding your posts. They speak for themselves adequately.

  32. Apteryx, if you think that calling me names will distract me from the fact that you claim that artemisia was used to treat malaria for a very long time by traditional Chinese healers because they recognized that it was effective yet you have failed to give a single reference when asked, you are sadly mistaken.

    If in fact you have such a reference or references and if they are reliable, I will believe your statement, but without them all the name calling in the world and all the arguing will not convince me that your statement is correct.

    Neither has your name calling prevented me from being amused by the fact that you so carefully pointed out to me that I cannot believe everything I read on wiki, while you apparently expect me to believe what you, an equally anonymous person on the Internet, says but fail to provide a reference for and which in this case happens to be the opposite of what is posted on wiki.

    Now are you really so upset about my statement, which I stand by and repeat, ““Civilization had to crawl before it could walk. I just hope people have the good sense not to get down on all fours again,” because you are very sensitive and concerned about human beings from diverse cultures or are you just another person promoting crude botanical drugs for emotional reasons who calls people names to distract attention when they ask you for references you can’t provide?

    You have already told me that you have no financial connection to the supplement industry so without evidence to the contrary I will not state that you do. However, if you deny an emotional attachement, I will not believe you based on your posts although I will readily admit that not knowing who you are I have no idea what your emotional attachment is or why you have it.

    I do hope that many of the scientists and MDs on this forum are listening because you are using all the marketing techniques that have so successfully been employed to get head-in-the-sand medicine into scientific institutions and I assure you that all my ancestors would turn over in their graves if they knew.

    I also note that you ranted about “my culture” even though you have no idea which one or ones that is. Your statement that, “For you to assume that that means these cultures can have no information of value that yours doesn’t already have, and that information can and should flow only from yours to theirs, is simple arrogance.” I agree completely that if I assumed any such things it would be “simple arrogance”, but those are not my assumptions. Those are your assumptions about me. You have either jumped to conclusions about me without knowing me, or else you are deliberately calling me names to distract from the fact that you have not provided the reference I requested.

  33. apteryx says:

    I said that a specific statement of opinion you made, or its specific phrasing, sounded arrogant and ethnocentric. That is not a compliment, but it is also not “name calling,” nor “ranting about your culture.” You feel that I am making emotive arguments, but your above post is entirely emotional in nature. The assumption of Western science that everything should be argued based on pure reason, with feelings having no place, may or may not be correct – but if that is the goal, we have all been falling down on the job a little here, and could all stand to improve.

    I will agree that I have emotional, or at least philosophical, reasons [beyond my own experience and observations] that cause me to have a slight prejudice in favor of traditional medicine, just as you have emotional reasons for a prejudice against CAM. Maybe those perspectives have something to offer, even though they are not strictly data-based.

    I do not have access to any ancient or 20th-century Chinese herbal literature, as I unfortunately read no Chinese, and before the last few decades, very little on TCM was available in English. So I do not have the language skill or expertise to supply you with a thorough history of the uses of Artemisia annua in China. Anyway, you indicated in an older post that it would not be enough for me to show that it was used; you expected me to prove also that it had worked. I have informed you that clinical trials of crude artemisia have demonstrated that it provides effective relief for malaria sufferers. Apparently, you did not view that as evidence that it had probably also been effective when ancient Chinese healers used it. I therefore see no prospect that anyone could offer evidence that would satisfy you. For my part, knowing that “proof” is an impossibly high standard, I am willing to believe that historical use plus recent clinical and animal study support creates a high presumption of efficacy.

  34. Joe says:

    rjstan said that Artemisia fell out of use for a while, and apteryx said that was wrong. Now, from apteryx “I do not have access to any ancient or 20th-century Chinese herbal literature, as I unfortunately read no Chinese, {snip}. So I do not have the language skill or expertise to supply you with a thorough history of the uses of Artemisia annua in China.”

    So, apteryx, you had no basis for your objection. Are any facts you assert … well … facts? You sound arrogant and ethnocentric.

    Apteryx wrote “… just as you have emotional reasons for a prejudice against CAM.”

    No, not emotional reasons (that is wishful thinking on the part of alties)- we have practical reasons. When we discovered how easily we fool ourselves; we developed science to avoid that pitfall.

    We cannot educate you about science in this format. Unfortunately, I cannot recommend basic books for you to study (they are just not in my, personal library); but they exist.

  35. Apteryx on April 4 I asked, “Aside from cinchona, do you have hard evidence that traditional healers effectively and routinely treated malaria with artemisinin or any other botanical? I don’t mean evidence that they used it but rather evidence that ‘it worked’. A scientific reference would be best, of course, but if that is lacking, is there a reliable historical reference?” I thought that from the rest of the post my meaning was clear. If it wasn’t, then I would certainly think my post of April 6 in which I wrote, “From this (refering to what I wrote previously in the same post) I assume that unlike cinchona, the plant’s effectiveness in treating malaria was not obvious to traditional Chinese healers or their patients,” would certainly have clarified what my question was. If I understand your post directly above correctly, you answered my question in it. You said that you don’t know whether or not it was obvious to TCHs that artemisia was effective. Am I correct?

    You are correct in assuming that I would not accept positive results from in vitro studies today as evidence that traditional healers actually noticed that artemisia was more effective against fevers than the other 199 botanicals that they used to treat them, but I certainly would agree that it most probably would be true if someone came up with a good historical account such as those that exist for cinchona.

    If you define CAM as a medical system that does not believe that high quality, objective, scientific tests are the only way to accurately evaluate drugs and therapies, you are correct in saying that I am prejudiced against it. I was injured when I was quite young because a medical doctor who was a good, caring human being was naive enough to believe fraudulent ads from drug companies in an era when they were not highly regulated. If he had tried to verify the claims independently, he would have seen the journal articles I have which are older than I am warning him of the fraudulent ads.

    When I hear people making medical claims or passing off assumptions as facts and when they cannot substantiate them, I am like a cornered animal. It doesn’t matter who is making the claims. I would react the same way whether or not it were a traditional healer or a Nobel Prize winner with a PhD and MD. And I am very opened about that with myself and everyone else.

    Unless we are having a problem communicating, I understand you to be making statements that I have heard alts make many times but never seen anyone give a shred of evidence to substantiate. For instance, that there is more than one chemical in most or many botanical drugs that cause it to effectively treat specific diseases and that the traditional medicine that was practiced by all our forebearers actually worked, or worked a great deal of the time. The second in particular flies in the face of all that I know about the subject.

    If you have good scientific evidence for the first and historical evidence for the second, I will be convinced. If you do not and you simply state that you believe those things are true, it will not bother me in the least, but if I think you or anyone else is stating them as facts without having evidence to substantiate them, I will be furious.

    As I’ve tried explaining repeatedly, with me it is personal. But you know what folks, it is personal with an awful lot of the general public and with a lot of MDs too. It is one of the major things that makes medicine different than the hard sciences. It is something alts face and something academic medical doctors will have to face sooner or later too.

  36. apteryx says:

    Sorry, but I still don’t know where you have set the bar. Traditional healers believed the plant was useful; they believed they saw it relieving symptoms. Clinical trials – in vivo, in humans, not in vitro – have shown that it does just that. Apparently, because other botanicals were also used in China to treat malaria, you will not accept these facts as evidence that this plant’s effectiveness was “obvious” to Chinese healers, or that they “noticed” it.

    It is vanishingly unlikely that all of the other antimalarial botanicals in China (the precise number 199 is now being bandied about without citation) were worthless; this claim seems to have been invented from a shred. You seem to have accepted it, and to be implying as a consequence that you will not admit that Chinese healers “noticed” the value of artemisia unless someone can prove that healers with access to it agreed that it was superior to every other available plant. Maybe I am overstating your demand, but it seems like not by much. Since this thread is off the recent posts, and neither of us is likely to convince the other of anything, we may as well let this subject drop. You can have the last word on it.

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