Antimalarial tea — from herbal remedy to licensed phytomedicine

ANTIMALARIAL TEA — FROM HERBAL REMEDY TO LICENSED PHYTOMEDICINE

Malaria is a critical health problem in West Africa, where traditional medicine is commonly used alongside modern healthcare practices.

An herbal remedy derived from the roots of a weed, which was traditionally used to alleviate malarial symptoms, was combined with leaves and aerial portions from two other plants with antimalarial activity, formulated as a tea, and eventually licensed and sold as an antimalarial phytomedicine.

The fascinating story and challenges behind the development of this plant-based treatment are presented inThe Journal of Alternative and Complementary Medicine, a peer-reviewed publication from Mary Ann Liebert, Inc., publishers. The article is available free on The Journal of Alternative and Complementary Medicine website until May 14, 2015.

Dr. Merlin Willcox (University of Oxford, U.K.), Dr. Zéphirin Dakuyo (Phytofla, Banfora, Burkina Faso), and coauthors discuss the antimalarial and pharmacological properties of the herbal medication derived from Cochlospermum planchonii (a shrubby weed known as N’Dribala), Phyllanthus amarus, and Cassia alata. The authors provide a unique historical perspective in describing the early evaluation, development, and production of this phytomedicine. They present the ongoing research and challenges in scaling up cultivation and harvesting of the plants and in production of the final product. The article also describes other traditional uses of the medication, such as to treat hepatitis.

WHY IS WHO OPPOSED TO AN EFFECTIVE ANTI-MALARIAL TEA

Which is why you may be surprised to learn that the World Health Organization and a majority of malaria researchers are adamantly opposed to it. To be fair, there are compelling reasons not to endorse an herbal tea in a fight against a potentially deadly disease. After all, conventional single-molecule drugs are honed through chemistry to be safer, more specific, and more effective than their herbal progenitors. More critically, malaria experts worry that unregulated use of this tea could cause the malaria parasite to develop resistance to artemisinin drugs.

But the tea’s mere existence and its rapid spread challenges the view that conventional pharmaceuticals are the best and only way of managing Africa’s health care problems. After all, experts in the international aid world talk a lot about sustainability, and nothing is more sustainable than a drug grown on a shrub… The story of artemisinin demonstrates that even the best malaria drugs are worthless if they are not getting to the people who need them. …

The tea has become widespread enough that last year the WHO published a statement opposing it for either treatment or prevention of malaria, and an online survey of malaria experts found that 72 percent were opposed to its use in prevention. Their view is that low-dose, persistent use could breed resistance, which would be disastrous. But we’re not talking about pumping pigs full of unnecessary antibiotics. We’re talking about desperate people trying to live normal lives. And, in Wagagai, after years of preventive use, resistance has not sprung up. Ogwang says that may be because the tea, like other herbal products, contains multiple active compounds besides artemisinin. Cinchona bark is still effective after hundreds of years even though chloroquine (a derivative) is not. The Chinese have been using wormwood for more than 1,500 years for a variety of ailments, but the only place where we’ve seen signs of artemisinin resistance is on the Thai-Cambodian border, where conventional ACT artemisinin drugs are used….

Ogwang is now trying to test whether the tea remains effective for prevention even if the artemisinin is eliminated, an idea that sounds crazy but that could eliminate the objection that the tea could stimulate resistance. …Some herbs do have medically active compounds, albeit with varying levels of efficacy, and Africans are choosing to go that route because they know that drug supply won’t be cut off by war or corruption or bureaucratic incompetence. Herbs are not always going to be the right strategy, but the data about these unconventional interventions should be shared and discussed. In the case of malaria,…there have long been indications that using a cruder, cheaper whole-plant extract could potentially be more effective and cheaper..

In a study conducted in rats last year, University of Massachusetts researchers compared a single dose of pure artemisinin to dried whole leaves, and found that the whole plant was better at killing malaria parasites…